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Declaration ot Domicile and Citizenshlp (
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TO THE STATE AND COUNTY TAX ASSESSOR,
ST. IUCIE COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in soa~~danoe and ~
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in conformity with Chapter 222, Settion 222.17, Flarida Statutes.
1 was formerly a legal resident of C1IIC322ri8tt1 Oh10
(City) (StaM)
and 1 resided at 6134 8id~ye ACTeB Dl"iYe .~N,eV~ ~ have changed my domic}le
(Street end Number)
to and am and have been a bons fide resident of the State of Florida since 26tb day of
Oc~ber ,~9 69, and i ~eside at 2973 Santa Anita Street
(Sheet and Number)
FORT MERCE, SAINT LUCiE COUNTY, RORiDA
and this stntement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Fb~ida.
(Insert here any pertinent fads, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence and applying for homestead
FilEO AN~ RECQROED
ST. t~UCIF COUPJI`1r. F'LA.
~ilF'FC
'7J ~1F;~ ~ 5 p~ 1~838~
2 ' 34
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CL_RK ~^.JtZ~(J~T COURT
I RJftTHER CEltTIFY that 1 will oomply with all other requiremenn of a legal resident of this State.
I fURTHER CERTIFY that 1 have no intentior~ to retum to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAMTIUCIE COUNTY, FLORIDA, permanently.
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Sworn to and subscribed before me this - 15 th day of Jsriusl`Y ~q 70
R ER POITRAS
CIRCUIT C URT Notary Pubiic
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BY D.C. My Commiuion expires
ffo b~ ~x~cuhd !n duplicah and ori~ina{ fll~d with Cf~rlc Grarif Co~r~, and duplicats with t~c ~.j
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13 800K1~~ PACE 8~8 ,
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