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Deciaration ot Domicile and Citizenship ~
163195
TO THE STATE AND ~OUNTY TAX ASSESSOR,
Sl. lUC1E ~C~UNTY, FIORIDA:
This is my declaration of Domicile and Citiza~ship in the State of Ff~~ida that I am filing this day in acoordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
;
i
Lexingtoa Michigan ~
1 was formerly a legal resident of ~ ~
(Ciy) (State)
5$61 UttiOtl Street _~WeV~ ~ havecha m domi~jle
and 1 resided at - - ^9~ Y
(Street anci Number) ;
ro and am and have been a bona fide resident of the State of Florida since lst day of
November 67 3707 Ridgehaven Ro°d
_ , 19 and I reside at
(Street anc Number)
PORT PIERGE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Ho~ida.
(Insert he~e any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, remova) of family to new domicilc, purchase of home, etc.)
Establishing residence and applying for Homestead
FILEO AND RECORJED
ST. ~UCIE COU~JTY. FLA. _
. RECORD VE~IFIED
163195
'68 JAIU 2 PM 2: 3 3
~ - .T ~ ~ -
~ =UJI_ '~1~ ~ ~~'.i•S
CLERK CIRCUIT COURT
I RIRTHER CERTIFY that I will oomply with all other requiremenri of a le~al resident of this State.
I FUiRTNER CERTIFY that I have no intention to retum to my former domitile, and I intend to remain in FORT
PIERC~; ;~?lNT. LI~CIE"ElJUNTY, FLORIDA, permanently.
- . . r
. ' (Name)
L~.'-. E. B. ~Meyer
- (Address)
Swarn to and subscribed before me this day of ~ Ta,,,.~.rv , 19~l.8.
ROGER POITRAS
CfRCUR COURT Notary Public
gy ~~~~L~ D.C. My ~ommission expires
(To b~ ~x~cutad in dupllcah~ and ori~inal Rl~d with CIKIc Circ~ri~ Cour~, and duplicat~ with Tax Ass~s~or.)
- BOUK 1 V~ PMG[ zsls .