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Dsclarr~tion~ ot Domi~ile and Citisenzhip ~-66'761
TO tHE STATE AND COUNTY TAX ASSESSOR,
Sl. tUC1E COUNTY, FlORI~A:
Thia is my declaration of Oomicite and Citize~ship in the State of Florida that I am filin~ this day in aoocrdanoe and
~n oonformity with Chapte~ 222, Section 222.17, Florida Statutes.
f was formerty a tegal resident of Ne1u YOr~ Idcr YerY
(City) (Stats)
a~d t~e:~ded ar 48 Terre H~s Lane,,$~rosaet L. However 1 have chamged my domi~ta
j (Street snd Numbe~)
b and am and have been a bona fide resident of the State of ftorida since 27th day of
---MSZCh-- , 19_b$-, and I ~eside at
(Street and umber)
FOAT PI~CE, SAIN? LUC1E COUNTY, RORtDA
and this atatement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(tnsert here any pertinent fatts, suth as sale of property or business, or relinquishment of employme~t
at former domicile, removal of family to new domicile, purchase of home, etc.)
. ~ Establish Residency for hoseatead purposea.
~ FrLED aN0 RECOROED'
ST. LUClE COUNTY. FLA. -
R~COR~ V~RlFl~D
166761
" - '68 MAY 3 A~t 9: OZ
~~k~ .
. ~OU~~ P017RAS
LERK CIRCUIT COURT
s
! RJRTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. s
1 FURTHER CERTIFY that I have no intention to retum to my fo~mer domic.ile, and I intend to remain in FORT
PtERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
(Name) Waltet T. Le01~1
(Address) ~
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~i`~rQ?ASto`a+~d~~v. before me this - 211d day of K q , 19_48
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