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Deciaration ot Domicile and Citisenship
163820
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Uomicile and Citizenship in the State of Florida that I am filing this day in attordance and
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes.
I was fo~merly a legal ~es~denr of __~orth _ Branch New YorY
~C~ty~ (State) ~
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and I resided at _ However I have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ~?th---_-- day of
September 19 6~ and I reside at18O8 COZ'81 AV@. !
(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 Florida.
(Insert here any pertinent fatts, such as sale of propery or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishin~ rBS~dence and applying for homeatead
FILED AND RECORDEB~
ST. IUCIE COUNTY. RLA.
RE.COR17 ~lil3il~~
- 1 '68 JAN 25 AN 10: A4
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` FiOGE=R i 01TRA ~ ~
~ eIERK CIRCUI7 COURT ~
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a(egal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
,`.~~i:: .~i~:~, ~ ~ .
~ • ' ' • ame)
~ . . ; Floyd ~ l~ootz
~ _ J•ti ~ ~ ~ _ ~
~ J'`•.. • x~:
~ , Edns J. Yoot~
~ ~ ^ ~J ?
~ ''Sv~iq'rp,tp~•~~d subscribed before me this ~5th day of JBAUal"Y , 19~.~.
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~ ROGER POITRAS )
~ LERK CIRCUIT COURT Notary Public ~
~ g ~G~'~~ D.C. My Commission expires ~
~ y ~
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(To b~ executed in dupliuh snd originsf ~ilsd with C{erlc Circuit Court, and duplicate with Tax Ass~ssor.) ~
~ eaoK 170 ~acE 6` EO
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