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~luation ot Domiail~ and Citis~nslNp ~~3~6
TO THE STATE AND GOUNTY TAX /~?SSESSOR,
Sl. lUC1E COUh"~lf, FLORIDA:
This is my dedaration of Domicils and Citizsnship i~ the State of HorWa that i am filin~ this day i~ aoo~rdana ~nd
in aonformiiy with Chapt~r 224, Section 222.17, Floride Statutes.
~ was form.rly a Ieqai rosid~nt of Miami Florida -
(Ciry) _ (Sta»)
and ~~~dsd at 1916 NMT 88th Ter race
(Strsst and Number)
to a~d am and heve baen a bona fide rei~dent of the Staro of Florida sinoe Sept . 6 ~y ~
, 19 68, a~ i~~ ~ 143 Lobster Road - Port St. Lucie
, (She~t s~d Numbs~)
~ORT N~C~, S~AMlT L11CIE COIMlTY, RORIDA
and this statement is to be taken as my decla~ation of citi~enship, actual le~al reiidenos and domidle in the Stats of Horida.
pnsert here any pertinent facts, auch as ~le of property or business, or relinquishmsnt of employmeM
at formar domicile, removal of family to new cbmicile, purchsse of horne, etc.)
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Intent of filing for hosestead
RlLEp ANO RECpADED?
ST. LUCIE COUN7Y. l~~,-
RECORD VERIFIED
. 1'73~t66
'68 DEC 3 I AN I I: 2~
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~DUk~ ~OITRAS ?
CIERK CIRCUIT COURT,~ ~
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1 RJRTHER l~ftTIFY that i will oomply with all otF~ rec~inmsnt= of a lepal ~eside~t of this Stab. ~
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I FURTFIER CERTIFY that I have no intention to retum to my former domitile, and I intend to ~emain in FORT
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PIERCE, SAINT LUCIE COUNTY, fLORIDA, permanently.
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- ;~L';='~ MaR1°) Berry Montrief
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~ - ~ : 31st December 68 i
' S~w~orrt.l~q,and~subscribed before me this day of 19 . E
,;!~;;,r ~ fJ ` i, ~
Roo~R''ron~?s ~
li~K C~Wf COt~T Notary Pubiic ;
By ~ D.C. My Commission expiros
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tTi i~ ~oaa!«i M d~N and o~ Al~d wUi~ CIKk ~ Cow~, ~nd d~piicaN wiN~ Tax A~~a
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