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Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. IUCIE COUNTY, FLORIDA: '
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _PD]~Tl11_- TeOI1C35tl~
~~;y~ (State)
and I resided at ~8,011tE.-_1__ However 1 have changed my domicjle ~
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since .~~~h day of
_J1aly_ 19
6?, and I reside at 1022 South 7th Street
(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 ihe State of Florida. `
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establish residency for homestead exemptiop. ;
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~ILED AND RECOR~ED~. , }
ST. LUCIE COUNT~Y~FLA. >
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~ •68 FE8 2i AM I I: I~ . ;
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~ CLERK CIRCUIT COURT
I FURTHER GERTIFY fhat ! will comply witfi all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiGile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. _
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(Name) AgOe ~,pu Jones
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,F (Address)
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~ Sworn to and subscribed before me this 27th day of Februarv ~ ~q 68
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~ ~~RC?GER ;~btiBAS t
~ ~ ~ :G4ERK C~RC~IIY:tOU T Notery Public
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~ g ~ ~ . ' ' ~ D.C. My Commission expires
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~ ; j~o.6~ ucgc~ifsir ~ii dvpKt~ and ori~insl filed with C{Klc Grcuit Cour1, and duplicat~ with Tax Ass~swr.) `
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