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~eclaration ot Domlcjte and Citize~ship 17'3~0~
TO THE STATE AND COUNTY TAX ASSESSOR, • ~
Sl, IUCIE COUNTY. FLORI~A:
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This is my declaration of Oomicile and Citizenship in ths State of Florida that I•m filin9 ihi: day in aooorda~os snd
in tor?formity with Chapter 222, Settion 2?2.17, Florida Statutas. j
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I was formerly a legal resident of Ce11tT8t18 IlIi21o38
(City) (Sta») ?
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and 1 resided at 908 Aorth Walnut ,~WeV~ ~~~e ~arpsd my domkale ~
(Straet and Number) #
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to end em and have baen a bona fider resident of the State of Florida since OCtObeT 14 day of `
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68 1001 Mississippi Ave
- , 19 , and i roside at
(Street a~d Number)
FORT PIERCE, SAINt LUCIE COUNTY, HORIDA .
and this statement ia to be taken a: my declaration of citizenship, actual legal residence and domicile in~the State of Horida.
(lnsert here any pertinent facts, such as sals of propery or business, or relinquishment of employment
at former domicile, r~emoval of family to new domicile, purchase of home, etc.) -
~ ` homestead purposes
FIIED AND RECORDED~
ST. LUCIE COUNTY. ~
R~CORb VEatF~EO ~
1'~3.qpg
'69 JAN 16 PIy 3:08
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ROGE 0lTRAS
CLERK C curT couRj `
I RJRTIiER CERTIFY ihat 1 will oomply with all other requiremsnri of a Isyal resident of tfiis State.
! FURTHER CERT1fY that 1 have no intention to rotum to my fo~mer domivle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanentty. _
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~ ~ . ar„e~ Georgi ligar
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' . (Address) .
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Sworn to and wbsuibed befwe me th;s 16th day of January 19 69
ROGER POITR/?S ' ~ ' ~ '
CI~RK CIRCUtT CAURT Notary Public
gy _~v O.C. My Commissioin ~xpires
tt'o b. .x.wtad ia drpliul~ .nd ort~ia.~ rd.d wi* Ca..k ciraih c.~.+, .~d duPUc.N witi~ T.x Aa.....a
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