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T~he S~o~~eand County Tox ^ssessor, ~ ~
k~t~Tif V COU NTY~ FLOI RDA :
This is my Decicrotion of Domicile ond Ciiizenship in the Siate of Florido thot I am 4ilin~
this day in occordonce, a~nd in confonnity with Ssction 222.17, Florida Stotutes, os omended by
Chopter 26896, Lcws of 1951. ~
1 wos formerly a legal resident of C~'p~Q~'~ _ New York
ckr srot.
a~- ~ at x~a
.
However, 1 have chcnged my Damicile to and om and have been o bona fide resident of the Stcte
of Florida since ~e 3~~ doy Ma ~ 1969
of ------Y .
318 Ho Ave. Ri.ver Fask F't, Pierce Florida 33450
ond t reside ct ~ -----t----------------E------------~
S~ Lueie s~.»~ ~ r~.~.. ~ -
/ County, Florida. and this stotement is to be token os my Declarotian of Citize+~ship, actual le~gcl
residence cnd domicite i~ the State ot Flarido. (Insert he~ ony pertinent focts, such os sale of
properry or business, or relinquishment of employment at fomner domicile, removal of fomily to
new domicile, purchase of home; etc.)
~~d home in New York State May 23, 1969 a.nd retired from my emptoyment Apsi130,
1969 and a new home ba,s been built far us in Florida. which wa.s occup~ed September
3Q, 1969. ~ bave ta.ken a new position here in Florida and have a F1oMda tag on mq
car and a Florida.~ driver~s lice~se.
I Further Certify thut t wifl regisier at my locol address when the registration books reopen,
and c.ornply with o!i other requirements of o legal resident of this Stcte. ~ ~
I Further Certify that t hove no intention to retum to my former domicile, cnd 1 intend to -
remain ~n _R,iv_er Park F't. Pierce ----------------St_ Iucie
~ . c~r c«,~ev
Florido, pemnog~~~J~ ANO RECOROEO
ST. ~UC~E CQUNTY. FLA. - _
~%i: C~=~ V E R t F I E D -
185168 - - - No„~ H„~~
'S9 ~~OV S ~ ' ~ s ~ -
~rtic.- Ncme - Wife
s•0;;r~ -OISRAS
~L.Er~K C{r~CLiT COURT
Sworn b and wbstribed before me this ~~doy
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