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Declaration ot Domicile a~d Citizanship '
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TO THE STATE ANU COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and ~itizenship in the State of Florida !!~:=t ! a^~ ~~~;~a_ this day in acco~da~ce a~d
~n conformity with Chapter 222, Sectio~ 222.17, Ftorida Statutes.
I was formerly a legal resident of ffiineola _ New York _
• ~C~y~ (State)
and 1 resided at _ 36 gerillWOrth R08d However 1 have changed my domiCile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 12~h day of
June , ~q 68 , and I reside ar . 418 Coconut Avenue (~v .Qr Park)
(Street and Number) ;
FORT PIERCE, SAINT IUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaratio~ of citizenship, actual legal residente and domicile in the State of Horida.
(Inse~t here any pe~tinent fads, such as sale of property or business, or retinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
Change of citizenship to the State of Florida
Homestead exemption purposes, etc. ~
FILfO AND RECORDED
ST. LUCIE COUNTY. FL.A.
~::^nan ~.I~D
'6$ ~ 1 AM 10: 31
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j :~f3;'r_r ~~0!-TR~S
~ CL~RK CIRCUIT COURT
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I FURTHER CERTIFY that I will comply with all other requirements of a le~al resident of thia State~.
1 FURTHER CERTIFY that I have no intention to return to my former domitile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, fLORIDA, permanently.
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~ (Name) ra on Donahoo
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ar e . ~oo
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~ (Address) 4 ~ g Coconut Avenue
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worn to.eru3~;ubxribed befo~e me this ~ s t day of _At1~us t , 19~~.
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~ . - ROGER lAfi~S
- p~K C~~~;pV~ Notary Public
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gy ~ Cx. .C. My Commission expires
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(Te b~ ~aaeol~ M duplieah and ori~ieul fil~d whM C1NIc Cirar~f CouA, and d~plkal~ witb Tax As~e~.)
600K~~ F! ;f
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