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Deciaration ot Domicile and Citizenship 164?~36
TO THE STATE AND COUNTY TAX ASSESS~R,
Sl. IUCIE COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and ~
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~n conformity with Chapter 224, Section 222.17, Florida Statutes.
I was formerly a legat resident of ___~ke_~ LUIC _ N• C. _
(Ciy) (State) ~
Mi 11 Spri=1g3 Rt .#t2 . However I have chan ed m domic.ile
and 1 resided at - - - - 9 Y
(Street and Number)
to a~d am and have been a bona fide ~esident of the State of Flo~ida since 25th day of
67
October g 333 Notlea~ Dr.
. . _ _ 19- and 1 reside at _ - - - _
(Street and Number)
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FORT PIERCE, SAINT LUCIE COUNTY, fIORIDA !
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 facts, such as sale of prope~ty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FILING FOR HOMESTBAD PURPOSES
FILED AND RECORDED' ~
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tLU I.,'rpUp~TY, F~A,
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'6$ FEe z 1 P~ Z; ~ 2 $
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~ I FURTHER CERTIFY that I will' comply 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 domiGle, and I intend to remain in FORT .
~ PIERCE, SAM1T LUCIE COUNTY, FLORIDA, permanently.
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a (Name)
~ . ~ GLBN EDWARD CLONrZ
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- ~ , . - . . B~?xxea~u J. cLOrrrz
~ 9worn to,and subscribed before me this day of , 19 -
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~ • ~ RClG~IC tT
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e;; ~CLf~RlC R COURT Notary Public
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? gy D.C. My Commission expires s
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~ (To be ex ~ in dupliute snd original filsd with Cbrk Grcuit Courf, snd dupliut~ ~rith Tax Assessor.) 1
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