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o~claratio~ ot Domicii• and Cltis~nship 1~400~
TO THE STATE AND COUNTY TAX ASSESSOR,
St. lllClE COUNTY, FIORIDA:
Thi: is my declaration of Oomicile and Citizenthip in the State of Florida that I am filin9 this day in aoo~rdanos and
in aonformity with Chapte~ 22?, Secfion 22Z.17. Florida Statutes.
1 was formetly a la~asl rasident of G18BSbOro J•
(City) (Stah)
and I rosided at 121 Franklyn Road i~~ ~,y ~~~e
(Strset and Number) ~
i'o and am a~d have been a bona fide resident of the Staro of Florida si~oe ~~il 20 day of
, 19 68 , and I res'ide at ??9 LoIDes Street
(Sfraet a~d Numbsr)
1~ORT M~CE. SAINT IUC~ COUNTY, RORIDA
and this statement is to be taken as my declaratwn of citizenship, actual Isgal residenoe and cbmicile in the Stete of Horida.
qnsert here any pertinent facts, such as sale of property or business, or mlinquishment of employmant
at former domicile, removal of family to new domicile, purchase of fiorr~e, etc.)
r
homestead purpoaes
FILE~ AN~ R~~Y~~::
gT. WCIE CvER1~tED
R~ 1~4Qa.~
+gg ,lAH 20 p : 3~
~ €
cER Po~jR ouaT.
CLERK CIRCUIT C
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1 RJRTHER ~HtTIFY that I will aomp~y with all other requirenknb of a le~al rosidsnt of this Stste.
1 FURTHER CERTIFY that I have no intention to retum to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT UKIE COUNTIf, FLORIDA, permanently. ~
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- . ' (Name) JeAe Ryar. `
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:...-=~C;
J_•.r•~_titi'~ f~
~ ^ ; • , (Address)
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' . ~ 20 January , ~q 69 ~
~6~irorrl_to and subscribsd befo~e ms this day of •
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ROOER rOiTRAt
C~K CIRCIMT COtIR~ Notary Publk
9y ~ D.C. My commission •xpir.s ~
a• w.~.~ M a~.~. a.~t c~ c.~r. .a+ ~ T.~ ~«.«..a
t3 ~~TS ~i3?4
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