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Oeclaration ot Domicile a~d Citizenship I .
TO THE STATE AND COUNTY TAX ASSE550R,
Sl. WCIE COUNTY, FlOR1~A:
This is my declaration of Oomicile and Citizenship in the State of florida that 1 am filirp this day in acoordante and
in oo~formiy with Chapter 222, Section 222.17, Flo~ida Statutes. F
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I was formerly a legal resident of ~S ~o~"-es IO~ ~
(Ciy) (State) ~
. ~
and 1 resided at ~~402 GY`8~*+d Ave. . However 1 have chanqed my domic4le _
(Street and Number) ~
to and am a~d have been a bona fide ~esident of the State of Florida since fi*`st day of
.T»lv- - - , 19_68_, and I resid~ at H 2~ 621at T C.S. ?1.79 I~.P.~- S F- 9b,~37
(Street and Number)
FORT PIERCE,.SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flarida.
(Insert here any pertine~t 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.)
Fami.~y has never physically "resided" in Ia+a. Avn no property, did not vote in 1968.
Official military "ha~e of record~ is nax Port St. I,ucie~ Florida on all documents.
~ Purchase of homesite in this comruunity xas completed in June af 1968 through
General Development Corporation. It is iqy declared U.S. domicile of intent.
' Declaration of citizenship in St. I,ucie County, State of Florida
FILEO AND RECORDED '
ST. LUCIE COUMTY. FLA.
p~.rn~^ ~1= ~!~'~E~
-is95s~ ~ -
~
' '68 AU~ 14 Abl 10 : 0 6
c~~.~
' .,=_-F: :~o~rR: s
eLERK CIRCUIT COURT ~
I FURTHER ~ER71FY that 1 will aomply with all other requirements of a leqal'r~ident of this State.
~ 1 FURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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• (Name)
Box z 621st T.C.s. 21+79 ~
Ap0 San Francisco 9623? ~
(Address) f
Sworn to and subsuibed before me this day of s , 19
ROGER POITRAS `
GLERK CIRCUIT COURT Notary Publ'
gY ~ Nly Gommission expites ~~~i~
(To b~ ~x~cuhd in d~pliut~ awa , ril~ Ci~wM C~w~ ~ dupikat~ witb Tax Aswssora ~
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