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Declaration of Domicile and Cltltenshlp
TO THE STATE AND COUNTY TAX ASSESSOR,
S1. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 em fllinq this day in aooordante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly s legal resident of _ R f d oef 3 r• t d p. rtr u~~ T ~-~ 6
(City) (Stab)
and 1 resided at 128 Hobart St. However t have charged my domidle
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since 8th -day of
Septeaber , Iq 69 ~ and I reside at Ridgecrest Moblie Hose Part
(Street and Number)
FORT r1~CE, SAINT WCIE COUNTY, RORIDA
and this statement is ro be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(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.)
(Establish Residence
FILED ANO RECDRDED~
ST. LUCIaE ~ OURT~ EOLA•
1~~~~3 ~.
'69 SEP t a AM t i : 25
iiC.=R i'OITRAS
CLERK CIRCUIT COURT
I FURTHER CERTIFY that I 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 domicjle, and I intend to remain in FORT
PIERCE, SAINT I.UCIE COUNTY, FLORIDA, permanently. (~rris~
Mr~ jtrs Marty ~i~stoct
- . , :: - r; ~ (Name)
~,:J
~~' ~:
. ~ (Address)
• `K
.~ ~
~' 18th Seutevber , 19~?Q.
~.$wpm,tp~nd~subsuibed before me this day of
..
ROGER rO1TRA5
clRCUIT cowlT
By ~ D.c.
Notary Public
My Commiss'wn expires
Re be executed in duplicate and oriUinal filed with Clerk Grunt CovA, and duplicate with Tax Asaeaor.)
eooK 1?9 X2844
No. 13