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Declaratio~ ot ~omicil~ and Cfti:e~ship ;
TO THE STATE AN~ COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citize~ship in the State of Florida that I am fili~g this day in aooordanoe and
~n tortformity with Chapte? 222, Section 222.17, Florida Statutes. ~
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1 wes formerly a legal resident of p0lts1~0uth RhQde I~laed
(CiN) (S~•ro)
and 1 resided at _ SO Cbild3 Street . Nowever 1 have chanflsd my domkile
(Straet and Number)
to and am and have been a bona fide resident of the Stab of Florida sincs 25th day of
Ma~_ , 19~2, and 1 resttle at 151 Bstia sne -
(Street and Number) .
FORT ~IERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal retidence and domicile in the StaM o# Horlda.
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of employment
st former domicile, removal of family to new domicile, purchase of home, etc.)
EI~MPSTFAD PURPOSES ;
FILED AND RECORDED
~ ST. LUCIE COUNTY'EF~LA.
R E 1~~~Ga)U
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'68 JAN 4 AM 1 I: 5 0 ~
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::o~E~: ~ oi ~ a~s
CLERK CIRCUIT COURT
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1 RIRTHER GERTIFY that I will aomply with all other requirements of a layal resident of this Stste.
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I FURTHER CERTIFY that I have no intention to retum to my former damicjle, and 1 intend to remain in FORT !
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PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. `
(Name) 4
AI.B~~ANDBR AI.I.AN , JR . ~
151 F.STIA LANE 9
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` ~ ; . ;'t.. . _ (Address) .
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~°d °
=s . • 4~ JavUUtY 1968
=`5woin fo-an8'#ubsui~ed before me this day of • ~
. c~` ' . _ • ; ~.,ri ~
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~ ~~'-~l4~~T~ Notary Public
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gy D.C. My Commiuion expires
(To b~ ~x~arhd in dupliut~ and ori~insl Rl~d witb Clwlc Grwi1 Courf, and duplicat~ with Tax A'as~or.) ~
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