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Dectaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA: ~
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance a~d
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _
d'lAl1a8~.• lris.
(Ciy) (State) -
and 1 resided at 6232 N. _ Xindeor B1Yd. _~~„~ever I have changed my domicale
(Sheet and Number)
to and am and have been a bona fide resident of the State of Florida s+nce ~_?9th.,__ day of
_~ZY , i9 68 ~ and I reside at ~will be out of II. B. under Govern~ent
(Street and Number) 8ap 0~- ~ ~
.
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
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, such as sale of property or business, or relinquishment of employment
at fo~mer domicile, remova! of family to new domicile, purchase of home, etc.)
ssTSezrsHix~ ~GAZ Bssrn~oB
FtLE~ ANO RECOROEOi
ST. LUCIE GOUNTY. FLA. ~
~i~~C~Ri~ VFF2lF~FO
1s~~s4
~ auc ~ ~M ~ : ~ o
i~~~;~N ?'OtTRAS _
CIERK CIRCUIT COURT
I FURTHER CERTIFY that 1 wilt comply with all other requirements of a(egal resident of ihis State.
1 FURTHER CERTIFY that 1 have no intention to ~eturn to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORlDA, permanently.
~ ~
(Name)
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` „ i. L! i ~ ~i~~ ~ • .
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\ •j~ . ,
~1 • ' . ~ r: r' v ~ , (Address)
= ~ } ~ : ~ OZIVS L. FBa~r
, .
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- ` ' ~ . = , let AIIGU3T
; 5yvor~ t
aaec~i3ubxribed before me this - day of
_ - ~ ; : . ~968 .
.
~ • ' . y
~
4
'J!• ~
~ U COURT Nolary Public
BY U.C. My ~ommission expi~es
R~ b~ jn dyplleat~ and oriainal Rl~d witi~ Cl~lc Ckwit Guet, and duplieaN wifh Tax A~or.I
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