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Declaratioln of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ___ SO. ~dil. __-_
(City)
629 ldadison Avenue
and I resided at ______-_______ ~_._ _. ___
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since
Wisconsin
(State)
_. However I have changed my domicjle
July 18
day of
_ _____ , ~9 6~, and I reside ar ___101 1llorningside Blvd. __
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken ns my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residency in State of Florida
FILED AND REC~RDF ~A_
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ST.~~CiEnDVR~F D
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28 PM ~ ~y
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~'•p`' -R ~ OIT COURT:
CLERK CIRCUIT
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently.
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-' ~- - - ~' 18th
-Sworn to.aEid: ty4scribed before me this
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.•'~ERI~aRq~fT COURT
By D.C.
N
f~~~1f1e) Joel E. Johnson
~~
(Address)
_ day of July ~ 19 69
Notary Public
My Commission expires
Li
No. 13
(To be executed in duplicate snd original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
BooK 179 ~-~ 4~.
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