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Declaratio~ of Domicile and Citizenshlp ;
1F8352
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declarotion of Domicile and ~itizenship in the State of Florida that I am filing this day in acaordartce and
in conformity with Chapter 222, Sectio~ 222.17, Florida Statutes.
1 was formerly a legal resident of wom+n„ ~flt ~ Q Ohio _
(Ciy) (State)
and 1 resided at Rt Howevef 1 have changed my domicjle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since lst day of
_ June , ~q 66 and I reside at 260? l~orth Ave
- _ _ . (Street and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of florida.
(Insert here any perti~ent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
FILED AND RECORDED
Establishing residence ST, LUCIE COUNTY. FLA.
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'68 JUC I AM~
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'iQ~E'n ?•OITRAS
CLERK CIRCUIT COURT
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1 RIRTHER CERTIFY that I will comply with all other requirements of a leyal resident of this State.
! F~1RTN~R CERTIfY that I have no intention to return to my former domitile, and 1 intend to remain in FORT ;
PIERC~f~S~1DNT~kxf'Q~P'.,~flUNTY, FLORIDA, pe~manently.
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- - .4: ~ (Name)
` <<"'~'~ ~ H. ~i. Vineyar
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~ Cerol~ne Yineyard
Sworn to and subxribed before me this 1s t day of J~~ , 19 68.
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~ ROGER 'ORRAS
~ CIRCUIT C RT Notery Public
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v By - D.~. My Commissior? expiros
(T~ 1» ~ac~ iw du'lica~ a~ ~i~inal fiMd wNi~ Cl~k C•ie~aaf Cw~o, ana drplical~ wilh Tax A~r.?
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a~1 ~2 ~~~1545
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