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Declaration ot Domicite and Ctttzenship
TO THE STATE ANO COUNTY TAX ASSESSOR.
Sl. LUCIE COUNYY, FLORIDA: -~-E~SS9~r
This is my declarotion of Oomicite and Citisenship in the State ot Flo~id~ that 1 am filing this day in aoo~rdance ar?d
in oonformity with Chapter 222, Sertio~ 222.17, Florida Ststutes.
I was formarty a fegal resident of HIG~~ N•C•
(City) (State)
and 1 resided at 3904 Bevetly H312 Dr. ,~Wever 1 have changed my domiGle
(Street and Number) i
i
to and am and have been a bona fide resident of the State of florida since 1 st day of ~
i
Aigust 67 2418 Atlantic Beach 81vd. `
- . 19 , and 1 reside at
(Street and Number)
FORT MERCE, SAINT LUCIE COUNTY, FIORIDA
and this statement is to be taken as my declaration of citizenship, actual legat residence and domicile in the State of Hor;~'a.
(Insert he~e any pertinent fads, such as sale of property or business, or relinquishment of employme~t
at former domicile, ~emoval of family to new domicite, purchase of home, etc.)
FILING FOR HOIi+~,STBAD PURP06BS
PIIED ANO RECORDEO'
ST. LUCIE COUNTY, FLA.
^(~~C` Vc_ ~1.~ tt'I~
_ r _ . .
165692
'S8 APR I AH 8:55
~
c;~.,::~; ~'~tTR:•S
CLERK CIRCUIT COURT
I RIRTHER G'ERTIFY that I will comply with all other requirements of a leyal reaident of this Staie.
I FURTHER CERTIFY that 1 have no intention to retum to my former domic~le, and 1 intend to remain in FORT
PIERCE, SAINT tUCIE COUNTY, FlORIDA~,permanently. .
(Name)
~~,~`?'i~~"?''~1~~ RAYIrqI~ID STONB
G `J 1 i C
~''~b. 'i ''ii
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~ : '.t = (Address)
= ~j ~ : ~4 ~~•rs~? <it ~ s
~ ~ ~ G: -
; ' ~,:~Nb ~nd ~bscribed before me this lst " day of ~RIL , 1968 .
~i= •t..,,~~~.~rYi.•
/
''I~~ •~~•N~.r`~~~1~`
~ • ~t0~ ' ,
' jf ~y GR COURT Notary Public
8Y D.C. My Commission expires
fTo b~ ex~eut~d in dupljeaf. ,nd orianal filed wi~b q.rlc urwir eour~, snd duplluh with tax Ass~ssor.)
aooK171 P~E 471
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