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Dectaration ot Domtcile and Cttlzenship
1'73820
TO THE STATE AND COUNTY TAX ASSESSOR.
Si. lUC1E COUNTY, FIORIDA: `
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This is my declaration of Domicile and Gitizen:hip in the State of Florida that 1 am filiny this day in acoo~danoe and
in conformit~r with ~hapte~ 222, Sectio~ 222.17, Florida Statutes. i
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I wa: formerly a Ie9a1 ~esident of Lake Hiawatha New Jersey ~
(City) (StsM)
and 1 resided at 6 Daf iaCk Drive . Hcwever 1 have chan~ed my domidle
(Street and Number) ~
to and am and have been a bona fisJe resident of fhe Stste of Florida sinoe ~p~ day of
~ , 19 68 , and ~ reside ar 191 Calmoso Drive
(Street snd Number)
I~ORT MERC~, SAINT LUGIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, ar relinquishment of employment ~
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at fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
for homestead purposes
FILED AND RECOROEO
ST. LUCIE COUNTY. Fl.A.
RECORD VERIFIEO
1'73820 ;
'fi9 JAN 14 AN 10: 9
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ROG ROITRAS
CLERK IRCUIT COURT;
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1 FURTHER CERTIFY that 1 will eomply with all other rsquirements of a le~aal 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
PIHtCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
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, ' ~ : (Name) Norman E. Allen
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~ Sworii to and wbsuibed befo~e me this ldt h day of J a n u a r y , ~ q~Q,
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~RK CIRWR ~pNRT ~ Notary Public
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By ~ D.C. My Gommiuion ~xpi~es y
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