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DeCiaration ot Domicile a~d Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
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Sl. ~UCIE GOUNTY, FIORIDA: ~
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This is my declaration of Oomicile and Citizenship in ths Stata of Florida that 1 am filing this day in ae~rdance and
in oonformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal resident of worchester M8S8
(Ciy) (Stats)
and 1 resided at _ 15 Abbo~' St reet . However I have changed my domic3le '
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(Street and Number) '
to and am and have been a bona fide resident of the State of florida since Nove~be r day of
, 19 69, and 1 reside at 322g Oleander A~enue '
(Street and Number) ~
FORT PIERCE, SAINT Lt~+~:E COUNTY, ~LORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(Inse~t here any pertinent fads, such as sale of property or busi~ess, or retinquishment of employment
at former domicile, removal ot family to new domicile, purchase of home, etc.)
Filing for boa~estead exe~ption
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~ 1 FURTF~itit CfRTIFY fhat I will oomply with all other requi~ements of a Ispal resident of this State.
~ I FURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
~ ~ ~ - l ~~CX-
~ (Name)Sbsron A. Thibesult
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# (Address)
~ ~ ` 13 Januar 70
~ ~ Sworit to ~ar~i! subsuib~d before me this day of ~ 19 .
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~ 4•.~K CIRCtA~ COURT Notary Public .
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~ 8y , ~ _ D.C. My Commiuion expires ~
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~ Re b~ ~t~Whd in dupliut~ and ori~inal Al~d wiTh Cluk Circuh Cour~, snd dupllcst~ with Tax Att~or.)
~ dooK 182 ~~E 631
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