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Declaration ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LllCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Floricla that I am filing this day i~ accordance and
in cor.fc+rmity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of __~8r.r@-- _ Verment
(Ciy) (S~e)
and 1 resided at ________5~ _A~BI'_8 StZ'@@t However I have changed my domiGile ;
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ___1~.~ _ day of
. Se~tember ~9 67__, and I reside af 160 Seranata Court
(Street and Numbe~) ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA Port St.I,L1C38
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Ftorida.
(Insert here any pertinent facts, such as sale of p~operty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
Establish Residency for Hoa~estead Exemption
FtLEO ANO RECOROED
ST. lUC1E COU['~TY^GLQ.
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164`7''?'~
'68 FE8 28 11:51
:•~~~-?r.5
~~CRK CIRCUIT COURT
1 FURTHER CERTIFY that I will comply with at) other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no inter4tion to return to my former domiule, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, pe~mane~ntly.
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(Name) Ho111s C. I,amb
s
(Address)
,•••Sworn tai'and subscribed before me this day of T''pklTllSx'~ , 19~_.
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^ . ROGER, Rb,1tR~ _
~ C~ER1r CIRCq~T CBURT Notary Public
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By'-'~~ D.C. My Commission expires ~
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(To,b~ executed in dupliute and originsl filed with Clerlc Grcuit Court, and duplicsh with Tax Ass~ssor.) ~
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