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Decla~ation ot D9micile a~d Citiz~nship j?~ac~4 ;
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile and Citisenship in the State of Ftorida that I am filirq this day in aooo~danos end
in aonformity with Chapter 222, Section 222.17, Florida Statutes. ~
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Blowing Rock • F. C. ~
I wss formerly a legal resident of ~
(~itY) (Stah) ~
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and 1 r~idsd at Bo~c 353 . However i have chan~ed my domWie
(Street and Number) ~
ro and am and have been a bona fide resident of the Stats of Florida sinoe ~00• 7, 1968 day of
(2923 Pruitt Road)
, i9 , and i~;de a~ St. Zucie Country Club
(Street and Numbsr)
!'ORT N~CE, SAINT LUC'~ SOUNTY, RORtDA
and this statement is to be take~ as my dedaration of citizenship, actual legal residenoe and domicile in the State of Florida.
pnsert here any pertinent facfs, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchsse of home, etc.)
Ptirchase of home in Ft. Pierce, St. Zuaie County, Florida
Filing for honeetead ezemption. ~
F{L~p ANO RECOROEO
ST.~E
CORD YERIFIEDLA•
1'72C9~ y ~ ~
'68 NOY 13 AM I 1' 4
_ ~.x
~017R~S
; ROGE pUR7~
' CLERK CIRCUIT C ~
;
~
i FURTHER GHtTIFY that I will aomply with all otF~ requirsmenn of a Ispal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domitile, and I intend to remain in FORT
PIERCE, SAINT L~1CIE COUNTY, FLORIDA, perma~ently.
. t : ...111; ` "
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. ~ ~ . (Name) Harold W. Tribble
: ~ y:4.- _ ~
- .
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< < (Address)
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, :,..f'.~ ~ 13th November 68
Sworn to and s:.~~scribed before me this dsy of , 19 .
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ROGER POITRAS ~
q~RK CIRCUIT COURT Notary Pubiic
i
By D.~. My Commitsion expires
(Te b~ ~cteuNd in duplkab and ori~inal Al~d wilb Ci~lc G~wM CarN, and duplk~ with Tax Aaysor.)
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