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Declaration ot Domicile and Cittsenship
TO THE STATE AND ~OUNTY TAX ASSESSOR, t
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Uomicite a~d ~itizenship in the State of Florida that I am filing this day in eocordanoe and
in conformity with Chapter 222, Section 22?.17, Florida Statutes. ~
1 was formerly a legal ~es~de~,t of __waukegan I11. _
Kiy) (Stab)
913 Chestnut Street .~We„~ i ha~e d~a dom~c;~e
and t resided at ~9~ Y
(St~est and Numbe~)
I
ro and am and have been a bona fide resident of the State of Flo?ida since day of `
May 6? 3U1 Rio INar Drive .
- - _ _ - 19_~, and I reside at -
(Street and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc.)
Establishing residence
, ~
FILEO AND RECORDED
S7. LUCIE COUNTY. FLA.
RE:CORC ~/=RIt1~D ~
~ js~s
'68 J~!~! 4 PM !2: 3~1
6~
::1-.=._r .~o~;a:..s
CIERK ClRCUIT COURT
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1
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1 RJRTHER CERTIFY tfiat I will comply with al) other requiremenis of a legal resident of this State. ~
1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
: ~ ~ ~til''-~G~~ ~ ~~bk`"~
: ~ ~ , ~~(~i~. (Name
- . . ~ Lar+rence Hett
_ " : . -
~ .J~i - ' • _
~ (~C~f@SS~
~71, .k '
`~wat~to arWsubsuibed before me this 4t~ day of Janaury ~ 19 68
ROdER POITRAS -
CIRCUR COURT _ , Notary Public ~
gy D.C. My Commission expires
~
(To b~ ~x~culwl in duplicat~ and ori~inal fi{~d with ~ U~ai~Court, aad duplicat~ wi~h Tu Ass~s~.)
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