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Decla~ation ot Domicile and Cttiz~~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. lUC1E COUNTY, FLORIDA:
This is my decla~ation of Domicile and Citizenship in ths State of Florida that i am filing this day in aooordanae and ~
in conformity with Chapte~ 222, Section 222.17, Florida Statutea. ~
1 was formerly a legal resident of Aeptune City New Jereey
(Ciy) tState)
and I resided at 66 LoCUBt AVeliLte . However 1 have changed my domicile
(Sheet and Number)
to and am and have been a bona fide resident of the State of Florida since `Tuly 3'5 day of
_ , 19 68, and 1 reside at 175 BonitB Couz't
(Street and Number)
FORT r1ERCE. SAINT LUClE COUNTY, RORIDA
and this statement is to be taken as my decla~ation of citizenship, adual legal residence and domicile in fhe State of Horida.
(Insert here any peninent facfs, such as sale of property or busineu, or relinquishment of employment
at fomner domicife, removal of family to new domicile, purchase of home, ett.) ,
kor homesteed e=emption purpoees . _
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F;L~D ANO ~ECORDEO /
ST. lUCIE COUNTY, Fl.a. p~~
RECORD VERIFlE 3
1969 MAR I I AM (0: 34
C
ERK CIRCUI T CpU
RT
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1 RIRTHER ~HtTIFY that I will oomply witfi all other requirements of a le~al reaident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ (Name) Angelina Brenan
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+ Swpm 'end subsuibed before me this llth day of Januarv ~q~b
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q~K.~,tUfT tOURT Notary Public
8y ' , D.C. My Commission expires ;
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(Te b~ ~x~cvhd in dupNut~ snd aioiw~l Al~d wilb C~ek CirwN CouN, ~nd duplicMs whl~ Tax As~era i
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