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Deala~atio~ ot ~o~nicil~ and Citi:enship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORIDA:
ThEs is my declaration of Oomicile and Citizenship in ths Stats of Florida that I am filin~ thit dsy in aooordanos and ;
in oonformity with Chapter 222, Section 22Z.17, Florida Statutes.
1 was forme~ly a lagal ~esident of pi3catiM?ay New Jersey
~C;fy~ (State)
a~d ~ resided at 15 BrOtherhood Street _ ~V1eV~ my ~Kjle
(Street and Number)
ro and am and have been a bona fide ~esident of the State of Florida since 9th day of
~
p~tober 67 829 So 6th stteet !
_ , 19 , and I reside at
(Street and Number)
FORT'IERCE, SAINT LUCIE COUNTY, fLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residenoe and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of propery or busineu, or ~elinquishment of employment
st former domicile, removal of family to new domicile, purthase of home, etc.)
,
Establishing residence and applyiag for homestead
~
, }
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FILED AND RECORDED :
' ~i. LUCIE COUNTY. FLA. ;
R~CORD VERIFIEU ;
.~.~)a~i
' '68 JAN 8 PM !2: 57
~,o:;~~~ ;~o R:,s
CLERK CIRCUI7 COURT
I FURTHER CERTIFY that I wi11 oomply with all other raquiremenri of a(e~al resident of fhis State.
i
1 FURTHE~ CERTIFY that I have no intention to retum to my former domi~ile, and I inttnd to remain in FORT ~
!
PIERCE, SAINT LUC1E GOUNTY, FLORIDA, permanently.
.t.,:~ili:ii;~.
' ' •~•r~'/,, /
. • . ~ % ~ " f ~
' Name)
- -r • ' ' ~ 'r'•'' - Sidne L. Cohen
- . . . -
~ • ~ • ' t: ~ (i0tld~t~ ~
G4~~~;~~ : ~
' ..y„~~tt``' ' Janaury 19 68 '
....Sw~orri to and subsuibed before me this 8th day of . • j
;
4
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ROGER *OIZR/?S j
CIRCUiT CQURT Notary Public s
1J !
g 7G p,C, My Gommiuion expires
. ~
(To b~ ex~cvl~d in duplicsl~ aed ori~in~ fil~d will~ Cl~ek Cirarit Covef, and duplicah wifh Tan Aaytor.) ~
V ~
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