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Declaratio~ ot Domicile and Citisenship 1g4015
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my decla~ation of Domicile and Citizenship in the State of Florida that I am filing this day in attordante and
~n conformiry with Chapter 22?, Section 222.17, Florida Statutes. '
I was fo~me~ly a legal resident of _ ~1@w York _
(Ciy) tState)
and I resided at D_ _ND.~ 3 However I have changed my domiti~e
(Street and Number)
to and am and have been a bona fide resident of the State of Fbrida since ___'~Q~._ day of
- -OCt.Ober 19
6~.. and I reside at 3279 We$t Lake Drive _
(Street and Number)
PORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actuat legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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Eatablish Residency for homeatead ezemption
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aold home in New York
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AN~ ~EN'~Y' ~
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C~-ERK i
I FURTHER CERTIFY that 1 will oomply with all other requirements of a legal resident of this State. ~
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I FURTHER CERTIFY that I have no intention to return to my former domic,ile, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~;S ~"~1e~8obert E. Helle]c ~
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~ ,~~_'~SwQia, tb and subscribed before me this~+ day of February , 19 6g .
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. Roc~t ~iU~s _ .
~ CLERIC. GRC~UfT Cb RT Notary Public ~
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~ gy D.C. My Commission expires
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~ (To b~ ~icecuhd in dupliut~ and oripinal filsd with CIKIc Urcuit Couet, and dupliu» with Tax A~ssor.) ;
~ d00K~~ NACE ~ ~
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