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Decta~atlo~ ot ~omici!• a~d Citize~ship 163?36~
TO THE STATE ANO COUNTY TAX ASSESSOR, 1
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile ar~d Citizenship in the State of Florid~ that 1 am filin9 this day in aotorda~os ~nd
in oonformity with Chapter 222, Section 222.i7, Florida Staturos.
1 was formeily a legal resident of gow Blooafield pel'ln
(City) (Sta»)
and I resided at ~ 1~$ 1[83II QtZ'@At . However 1 havechs~ped my domic3le
(SKeet and Number)
ro and am snd have bee~ a bona fide resident of the State of florids since ~.rd dsy of
I
DCt~11Ler , i9~~, end 1 retide at 210 9 8 RBmie I?e21e . xiver ParY ~
(Street and Number) '
FORT M~CE, SAINT lUC1E COUNYY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual lepal re:idance and domicile in the Stats of Florida.
(Inse~t here any pertinent fads, such as sale of propeny or business, or ~elinquishment of er~nployment
at former domicile, removal of family to ~ew domicite, purchase of home, etc.)
Sstebliahing residence and applying for homeatead
F~IED AND R
ST. L11~~E COUN
~Y ~ED
~ECORO VERIFIEDLA'
,68 ~AH 9 P~ 3, js 2 -
Oq ,
CLER!{:,E c? ~p;7R~g
CrRccrr~-~DURT -
~
I RIRTHER CHtTIFY that 1 will oomply with all other requirements of a layal resident of this State.
! 1 FURTHER CERTIFY that 1 have no intention to return to my former domiple, and I intend to ~emain in FORT ~
~
j PIERCE, Sq(NT•t.~JCIE COUNTY, FLORIDA, permanently. I
~ ' ~ ?
~
. - _ ,;r. ~ .
~ ' ~ (Name)
" ~ • - H. Beaver ~tinehart- ~
. ~ ~ , -
~ ' . " ~ - ' c; (Address)
k - = i:; ,,~ti;
Sworn to and subsuibed before me this 9 th day of a~u~y ~ ~ 9 68
a~ rom~?s
CiRCUR ~OURT ~ Notary Public
1/
6y Z¢ ~~~~~~J D.G. My Commission expires
t
_ r
(To b~ ~arlad in dupiiuh an~i ori~inal fil~d witl~ CQINIR c prcuh tourl, and dupllcah with Tan A~s~or.)
~~69 ~E2848