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Declaration of Domicile and Citizenship :i82(j91 TO THE STATE AND COUNTY TAX ASSESSOR, Sl. tUCIE COUNTY, FLORIDA: This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and in conformity with Chapter 222, Section 222.17, Florida Statutes. I was formerly a legal resident of _ Rock Illand (City) and 1 resided at 100 13th Are. (Street and Number) I It (State) However 1 have changed my domidle ro and am and have been a bona fide resident of the State of Florida since 313t_ day of MQy 1969 , and I reside at 202 Garden Ave. (Street and Number) FORT NERCE, SAINT LUCIE COUNTY, RORIDA and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida. pnsert 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.) Entering Siarla S Hamilton in High School " Cheryl Lynn in Jr High ~ F;QED ANO RECORQ~D! , 3T. LUCIE COUNTY. FLA.. ' RECORD VERIFIED " Holly $ in Elementary school l$~9i '69 AUG Z I PM 1 : X13 Mr Hamilton .will apply for homestead exemption . ~~~ ROGER a OITRAS _ eLERK CIRCUIT COt~IR~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. 1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT Pliid~~;~~1)-~14T'.•.I,UCIE COUNTY, FLORIDA, permanently. ..... V f .~~ .. ' ~ ~.a 'r `~ rr ~~ ~©~ (Name) "i ~~W Herbert Mi. Hamilton _.- -. 'Ea f,~ ~' " ';. ~•. ~ (Address) ., ; ':,., -- 2; August 69 Sworn to .and subscribed before me this day of , 19 ROGiI~ F~ORRAS CIRCUIT COURT B a`-c'Ii'.c'~ ~ D.C. (To bo exeavted in duplicate and original filed with Cleric Circuit Court, and duplicate with Tax AsNSaora aoo~ 179 ~,~f 1348 No. 13 _ Notary Public My Commission expires