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Declaratlon ot Don~icile and Citizenship j'7358~ 4
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TO THE STATE AND COUNTY TAX ASSESSOR. ;
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51, IUCIE COUNTY, FIORIDA: ~
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This is my declaration of Domicile a~d Citizenship in the State of Florida that I am filiny this day in sooordanos and ~
i~ oonformity with Chapter 222, Ssctio~ 222.17, Florida Statutes.
I was formerly a le~al resident of Bradford Penn.
(Cify) (Stafe)
54 11eet Corydon
and 1 rosidsd at . However i have changed my domic~le
(Straet and Number)
b and am and have been a bona fide resident of the State of Florida since OC tober day ot
, 19 68 , and 1 reside at 1103 BeBCh COUTt
(St~eet and Number) ~
FORT M~, SAINT LUCIE GOUNTY, RORIDA i
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the State of Horida.
qnsert here any pe~tinent facts, such as sale of property or business, or ~etinquishment of employment `
at former domicile, removal of family to new domicile, purchase of home, ett.)
for homestead purposes
FILED AND RECORD~ .
ST.~LE
CO~n VuRIFIED
1'73889
'69 JAN I AH 11: 01
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ROG AOITRAS
. CI.EaK CIRCUIT COURT~
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1 RIRTHER CERTIFY that I will aomply with all other requiremenri of a le~aal resident of this State.
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1 FURTHER CERTIFY that 1 have no intention to retum to my former domic,ile, and I intend to remain in FORT
PIERCE, S14INT LUCIE COUNTY, FLORIDA, permanently.
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: _ ' ~ (Na ~ A. W. Grove ~
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~n ~ro and subxribed before me this 16th day of January ~ 19
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ROOlR rO1~RAS ~
CL~RI( CRWR Cp11RT Notary Publit ~
By D.C. My ~ommiuion expires
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