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Declaratlon ot Domtcil• and Citi:enship ~
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TO THE STATE AND COUNTY TAX ASSESSOR, ~ ~
Si. LUCIE ~QUNTY, FLORIOA: ~
This is my declarotion of Domicile and Citizenship in the State of Flo~ida that 1 am filin~ thia day in acoordanoe and
in oonformiy with Chapte~ 222, Section 222.17, Florida Statutes.
Reading penn.
I was formerly a legal ~esident of
(City) (State)
1217 Brool~ Blvd
and 1 resided at _ . However 1 hswe chanqed my domidle
(Street and Number) ~ ~
to and am and have been a bona fide resident of the Stab of Florida sinoe D~C . 31 day of
_ , t9 6?, and I reside ai i05 Naran3a Avenue
(5heet snd Number)
FORT PIHtCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my deciaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inse~t here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family ro new domicile, purchase of home, etc.)
for homestead purposes
FtlED AND RECORpED
ST. ~UCIE COUNTY, FLA.
RcCOR7 VER;Fl~O
1`~'Sb92 `
'69 M~R I 7 AM I I: 2 g d'~
~0~~ ~ ~-0lTR~S
CLERK CIRCUIT COURT
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1 FURTHER CERTIFY tfiat I will oomply with a!i other requirements of a IeQal reaident of this State. 2
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~ I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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_ (~`~a~) A21en L~ Diller, Sr.
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~ . . , . ' c~~•. (Address)
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. Swotit;~ end~subsuibed before me thia 1? day of ~~C~ , 19 69 .
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" i!OITRAS
~ ~ ~CIRCUR t0 Notary Public
By D.C. My ~ommiu'wn expires
- Qo b~ ~x~cut~d in duplicat~ sed ori~inal fil~d with ClKk Cira~it Courf, and duplicsN with Tac A»~aor.)
r~. ~ 3 BOOK PAGE ~~O
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