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Dealaratton of Domicile a~d Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR~
ST. lUC1E COUNTY, FIORIDA:
Thi: is my declsratio~ of Oomicile and Citizenship i~ the State of Florida that 1 am fili~g this dey in sooordar~o~ and
in oonformity with Chapter 222, Section 222.17, Flo~ida Statutes.
Chatha~ Yirginia
1 was formerly a legal ~esident of
(Ciy) (Stste)
Route 1
a~d 1 residad at . However I have changed my domidk
(Street and Number) .
ro and am and have been a bona fide resident of the State of Florida since ~4~?• 26 day of
,~9~, and i reside ar 307 Pernandina Street
(Sheet and Number)
PORT WERCE, SA1NT LUCIE COUNTY, RORIDA
and this ststement is to be taker~ as my declaration of titizenship, acfual lega) residence and domicile in the State of Florida.
(tnsert here any pe~tinent facts, such as sale of property or business, or relinquishment of emplayment
at former domicile, removal of family to new domicile, purchase of home, etc.)
FILEQ AND RECOROED
for homestead purposes sT. i.UCiE CoUNTy, FL~.
pn v~ t~•Fv
1`~5'7~~~
'69 MNt I 8 Q~~ ~p : 4y
s:~~,=_r ;~a,~~~s
. ~~-~'~K ~'RFWT COURT
~
~
f
~ I FURTHER CHtTIFY that i wii) aomply with al) other requi~ements of s lepal residsnt of this State.
i FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~.1...,~ ~
~ ~a"~~ Beulah R Tho~pson
~
¢
(Address)
~vKom"1o and subsuibed before me this 1$ day of ~=Ch t9 69 .
. ~ _ . .
~ . Rp~i~ PORRAS
' :C~ERI(~~CIRCUIT CQURT Notary Public
By: ~ . D.C. My Commiuion expi~es
(Ts b~ ~x~cuhd in duplicat~ and ori~ieal Al~d wifh C1~1c Urcuif Couef, snd duplka» wilb Tax Asaaor.)
No. 13 ~ ~
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