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Declaration ot Domicile a~~zen~hip ~
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FLORI~A:
This is my declarotion of Domicile and Citizenship in the State of Florida that ~I am filing this day in aocordance and
i~ conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Cortiand N~.v vnrtr
(City) (State)
and 1 resided at 380 TOntpki~l3 St. ~Wever I have changed my domic~ile
(Street and Number)
ro a~d am and have been a bona fide resident of the Stste of Florida since 3rd day of
MetrCh , 19
69 and 1 reside at 38~ St. Fr~tDCis Rd.
(Sheet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal ~esidence and domicile in the State of Horida.
(Insert here o.iy pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of famiiy to new domicile, purchase of home, etc.)
(Ho~estead B~cemption)
~ILED AN~ RECOR~E~.
S.~, WC~E COURi
Y~~LA•
rnRC~ ~ - _ _
la`~S2
' 10 : 59
~i '70 JAN 2 ~
l ~
i
~i~GE.F f QtSR"~URT
~ ~LERK CIRCU?T C
E
1 FURTHER ~ERTIFY that 1 will cc+~~ply with all other requirementa of a legal resident of this State. ~
I FURTHER CERTIfY that I have no intention to retum to my former domicjle, and I intend to remain in FORY
PIE~CE, SAINT LUCIE COUNTY, FLORIDA, permanently.
Henry Alexa der
~ ~ 1, ~ (Name)
~ . . -
~ : y. - 4 _ ~ ~ ' f
~ _ ;r _ _ 38~ St. Fraacis Rd. ;
~ , ~ ' : .
~ . - ~ ti : ' = ~ _ (Address) `
~ ~
' r . ~ ~
Swc~R:tO and subscribed before me this 2~d day of Januarv , ~q~,
• -..3 • - ,
~
~ ROGER POITRAS '
~ IRCUIT COUR Notary Public
~
~ By ~ D.C. My Commission expires
~ J
~ ~(To bs ~xecut~d in duplicat~and on'~inal ~iled with C1~rk Circuit Cour~, and duplics» with Tax As~r.)
~ 60011182 PACE z
~ No. 13
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