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DeClaration ot Domicile and Citizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my detlaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in atto~dante and
in rnnformity with Chapte~ 222, Section 222.17, Florida Statutes.
I was formerly a legal res~denr of L8nham _ kD
~~;~y~ (State)
9008 2n~ Stre€t
and I resided at However I have changed my domiti~e
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since JUrie 1~. day of
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, 19
69 , and I reside at ROUte 2~ $OX 3020 ~
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FORT PIERCE, SAlNT LUCIE COUNTY, RORIDA
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 pertinent facts, such as sale of property or business, or relinquishment of employment
at forn~~r domicile, removal of family to new domicile, purchase of home, ett.j ~
Filing for homestead eaemption FILED AND RECORDED ~
ST. LUC1F COUNTY, FLA. ~
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~70 ~a~~ s a~ i i 9
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CLERK ~IRCUIT COURT
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I FURTHER ~ERTIFY that I will comply with all other requirements of a legal resident of this State. ~
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I FURTHER CERTIFY that I have no intention to return to my former domicjle, and 1 intend to remain in FORT ~
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently. :
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(Name) Jo~n Lee Ball
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~ (Address)
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~ 6th January 70 ~
~ Sworn to and subscribed before me this day of , 19 ~
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~ • ' ROGER- l~i'!1~ ~
~ : . CL~ti( C1J~fIT:CpURT Notary Public ~
~ By. D.C. My Commission expires
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(Ts !N ixiwt~d in dupliub and originsl filed with Clerlc Circuit Court, snd dupliut~ with Tax Ass~s~or.)
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aooK 182 P~~E 228
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