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Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day i~ accordance and
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in conformity with Chapter 222, Section 222.17, Flo~ida Statutes. ~
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I was formerly a legal resident of WalthBID Aia88 • _
(C~y) (State) ~
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and 1 resided at -~aY~am 22 08k Hill ROad However I have changed my domici~e (
(Street and Number)
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to ar~d am and have been a bona fide resident of the State of Florida since day of
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. 19_ 69 and 1 reside at s~,
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Insert here any pe~tinent 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.) i
Filing for homestead exemption
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•FtLEO HfJD RECORDED
, ~~CIt COU~~TY, FL~.
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legsl resident of this State. !
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1 fURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ (Name) Jennie A. Ceh311
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~ (Address)
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~ Swor.n.to and subscribed before me this 6 day of January ~ ~q 70 ,
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ROGER PO1titAS
~ CLERK.CIRCUIT COURT Notary Public
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~ By D.C. My Commission expires
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~R (To b~ ~xecutsd in duplicat~ snd originsl filed with G~rk Circuit Court, and duplicat~ with Tax Ast~ssor.) ~
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aooxl$2 ~c~ 216
~ No. I3
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