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D~ala~atlon ot Domtalio and C~tis~nship ~ 1~'~~
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. UJCIE COUNTY, FLORfDA: . .
Thls is my d~clsrstion of Oomicil~ a~d ~tiunship i~ th~ State of ~id~ that 1~n filirp this day in ~ocordano~ and
in conformit~? with Ghap»r 242. Section 222.17, Florida StahrMs.
~ wss iormerir a ~.qal rosidenr of ~ Port Ch~9~ Hew 2orY
Ki~Y) . tStats)
and 1 ~sW~d at -;~'i~ 7eat ~heeter A~any,4 ,~K ~~w my ~~ti
(Stnst a~d Numb~r) . .
ro and am and h~ve bee~ a bona fid~ resident of th~ Stsro of Florida sinos~ ~t~ day of -
. ^"t~bo~ . 19~_, end I roside at 7~,4 F~cisa lfieta Blvds, ~~ort
t5tro~t and NumbK)
p~ ~ ~ ~ ~p~ St. Znois, ~'ort Pieroe, ~i .
~'lori~e
and this :tatbrr~ent is ro bs take~ as my ded~ration of dtizenship, actual Ispsi reskN~ and domidl~ in fhs Sta~e o~ Horida.
(Inse~t hero aMr pertinent fads, such a~ sele of property or bu~ness, or rolinqui~me~t of employm~nt
at former domidle, removal of family to new domiale, purchsss of har~e, etr.~
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$etablieh residency _ _
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1 RJRTHER G£it71FY that 1 w111 comply with all oth~r r~quirem~nri of a lepal residsnt af thb S~at~.
~ 1 FURTHER CERTIFY that I have no intention b rotum to my former domicjle, and 1 inUend t~o remain in FORT
~ PIERCE, SAINT LUCIE CC?UNTY, fLORIDA, permenently.
~ .
. (~n1e) Stells A~allone
~
~ ~
(~cldress)
~or;;'~,;~t~d.wb~«i~sa ~sforo,,,e rh;: 9th day ~ October , tq 68
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~ Notary Pubik
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~r ~ - ' _ D.G. My Gommission expires
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