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Declaration ot Do~nicile and Citizenship ;
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TO THE STATE AND COUNTY TAX ASSESSOR, 1639'79 . ~
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Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in aooordance and
in conformity with Chapter 222, Sectio~ 222.17, Florida Statutes.
I was fo~merly a legal resident of _ Clill~ap _ _ ~la. _
(City) (State)
and I resided at _ _ 225 High~,and Drive _ . However I hsve changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since -_~4~_-_ _ day of
_ Augu~t , 19~2, and I reside at 3106 Irlaravilla B1 vd
_ (Street and Number)
fORT PIERCE, SAINT LUGIE COUNTY, FLORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. t
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
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at former domicile, removat of family to new domicile, purchase of home, etc.)
Bstablishing residence and applying for homestaa~
FILED AND RECOROEp'~
8T. LUCIE COUNTY. ~'~1:~
RECORD VERIFIEO
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'68 JAN 31 PM 12 : y~1
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~oc~n ~oirRAs ;
I CLERK CIRCUIT COURT ;
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1 FURTHER CERTIFY that 1 will oomply with all other requirements of a(eQal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiCile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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_ ~n ' ~ ~ C.~,~J~~ ~ 8 • y7'?~Llst~l
, ..\,,t. _ c{'.~ (Name)
, , : r : Helen V. Ulillar
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' . : . . : ~ (Address)
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Sworn to and subscribed before me this 31 day of J8D8Ury , ~q_~$
ROGER POITRAS
CIRCUIT COURT Notary Public
g ~ D.C. My Commission expires
(To b~ ~x~cut~d~n duplicaM and ori~inal Rl~d with Cl~ric GrcuN Coue~, and duplicats wiTh Tax Ass~or.)
d~ ir~~ PACE ~
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