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Declaratioln of Domicile and Cltlzelnship TO THE STATE AND COUNTY TAX ASSESSOR, S1. LUCIE COUNTY, FIORIDA: This is my declaration of Domicile and Citizanship M the State of Florida that 1 am filing this day in accordance and in conformity v:ith Chapter 222, Section 222.17, Florida Statutes. 1 was formerly a legal resident of Norfolk Qirginia - (City) (State) and 1 resided at _ 6659 A8 . Beach Blvd . _. However 1 have changed my domidle (Street and Number) ro and am and have been a bona fide resident of the State of Florida since Aug . ~ 19 69, and I reside at ROUte 2 ~ Boz 1077A (Street and Number) FORT MERLE, SAINT LUCIE COUNTY, FLORIDA day of and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Honda. (Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment at former domicile, removal of family to new domicile, purchase of home, etc.) Darlene Carroll ~~~NaN has -come to permanently reside with married sisterhas mother is deceased and father in auto accident. (Mrs. Joan Owens) RILED ANO RECORDE©~ ST. LUCIE COUNTY. Fl.A.` RECOR[5 VERIFIED 182413 '69 AUG 29 PN 2 : 08~ Rt?G~R"~OITRAS CLERK CIRCUIT COURT' 1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State. I FURTHER CERTIFY that I have no intention ro return to my former domicile, and 1 intend to remain in FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. i (Name) Joan Owens (Address) ,-::+;:3:r,: ~Swom•ta6~~~bsuibed before me this 2~-th-- day of A~l~? ~ t , 19~..g. ,:~ • ,~ . .~ •Sr ~,_ " :. s,. CIRCUR : ~ Notary Public • Y R gy ~- D.C. My Commission expires f. - . (To be exe~cutad in dupliah and original filed with dark Cirarit Court, and duplicate with Tax Assessor.) No. 13 Y _ _ _ QOOK~~~ PIIi,E~~ ~~