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Declaration ot Don~icile and Citizenship ~650~1 ~
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
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Sl. IUCiE COUNTY, FIORIDA: I
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am fil~ng this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes. '
Grand Ra ids Michigan
I was formerly a legal resident of - -
' (City) (State) ~
371? Prances St. S.B.
and I resided at _ However I have changed my domicile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _____4th day of
D~cember 6T
19^--, and I reside at _.~.~_~anv~en Dliv~ I
(Street and ~lumber) .
FORT PlERCE, SAINT LUCIE COUNTY, FLORIOA
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, sush as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) _
Bstablishing residence
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FILEO AND RECORDEO' '
ST. LUCIE COUNTY. FLA.
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'68 MAR II PM 12:2 o~„~G~ ;
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CLERK CIRCUIT COURT
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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 1 have no intention to return to my former domicile, and I intend to remain in FORT
~ PlERCE, SAI(~T:.?UCJ~~~OUNTY, FLORIDA, permanently.
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~ • . _ (Name)
~ ~ - ; _ Chester L.. Saas
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, ~ . ' ~ ` (Address)
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~ llth blarch
~ Sworn to and subscribed befo~e me this . _ _ day of _ _ _ _ , 19 68.
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ROGER rO1TRAS
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~ K CIRCUIT OURT Notary Public
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" By _ ~''~~'L . _ ~~~"~`~'w`~-_-_- D.C. My Commission expires
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R~ b~ ~xacvNd in d~pllcN~ ~ed wioinal Hl~d ~~0 I~Gf ~~~~d d~ptisaN wi~h Tax Aa~s~-)
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