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Declaration ot Domicile a~d Citizenship - ~
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TO THE STATE ANO COUNTY TAX ASSESSOR, !
Sl. IUCiE COUNTY, FLORIDA:
This is my decla~ation of Oomiciie and Citizenship in the State of Florids that 1 am filing this day in aoo~rda~ce and
in oonfo~mity with Chapter 222, Sectio~ 222.17, Florida Statutes.
I was formerly s legal resident of Fort Worth Te~cas
(City) (State)
and I resided at 34A Thompso~ Stleet , However 1 have chanQed my domidle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 8tb day of
Scptember , 19 69 , a~ i at 407 Oleander Ave.
(Street and Number) '
,
FORT lNERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declarotion of citize~ship, actual legal residence and domicila in the State of Horida.
(Insert he~e any pertinent facts, such as sale of property or business, or relinquishme~t of employme~t
at former domicile, removal Af family to new domicile, purchase of home, etc.) ,
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Bstahlishing residence and a pplying for bomestead
FILED AND RECORDED~
S~• ~~1C~E COUNTY. FLA:
~~~~~F.Fo
1882~0
'10 JAP~ I 3 AM 9: 2!
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' CLERK C~RCUIj COURT~ ~
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~ I fURTHER CE~tTIFlf that 1 will comply with all other requirements of a le~al resident of thi: Stata. ~
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~ I FURTHER CERTIFY that 1 have no intention to raturn to my former domicjle, and I intend to remain in FORT ~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. - ~
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_ _ Andre~°"~~riffatoo
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~ - . 13 Januarq ?0
Swom to and•tubscribed before me this day of , 19 .
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~ ROGER POITR/1S
~ CIRCUIT OURT Notary Public
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~ By D.C. My Commiu'wn expires
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(To b~ ~x~cuMd in ~uplicat~ and orininal fil~d w~fb CIKic Cietiuit Coue~, and dupliuh with Tax Aau~or.)
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