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~eclaratinn ot Domicil~ and Citi:e~ship ~
' 1'75i12
TO THE STATE AND ~OUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FLORIDA:
This is my decla~ation of ~omicite and Citizen:hip in the State of Florida shat 1 am filin~ this day in aaoordance and
in oo~formity with Chapte~ 222, Section 222.17, Florida Statutes. .
1 was formerly a legal res~denr of Brookhaven Township N.Y. New York
(City) (Stst~s)
and 1 ~esided at _B S L't lE t t Rd Midd le I s 1 an d . Howevar I have cha~fled my domidle
(Streef and Number) '
b and am and have been a bo~a fide resident of the State of Florida since 17th day of
h'avember ,~q 68 , and ~ reside at 1217 Easter Ave.
(Street and Number)
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FORT M~CE, SAINT LUCIE COUNTY, RORIOA !
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and this statement is to be taken as my declaration of citizenship, actual legal residenoe and domiale in fhe Stab of Horida.
(Inse~t here any pertinent facts, such as sale of propery or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) t
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Bstablishing residence and applying for homestead
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:17'S~12
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,~o~ER ~osri~a'v' ~ ~
' ~LERK CIRCUit COURT
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i FURTHER CERTIFY that I will aomply with all other requirements of a leps) resident of this State. -
I FURTHER CERTIFY that 1 have no intention to return to my former domiqie, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. _
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~ : ~ . ~ . . (Name)
=~V; - " Helen B. Wilson f
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25th February 19 69
Swo~q:~ ~nd :ubscribed before me this day of , .
ROG[R ~QITRAS
CIRCUIT COURT Notary Public
By ~G~ D.C. My Commission expires
Re b~ ~x~aM~ M dupNuN aed e~ioinal tN~ wilb G~rl~ CMwiif Gwt, aed ~ieaN wiM~ Taoc As~~J
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: ~ , ~ ~ 2845
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