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Declaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida thst I am filing this day en aocordar?te and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was forme~ly a legal ~esident of S rp ingfield Virginia
(Cify) (Stsb)
and I resided at 650? Grono COIIZ`t ~Wever 1 have uhanqed my domitile
(Sireet and Number)
. lst
b and am and have been a bona fide resident of the State of Florida since day of
September 69 114 Rio Mar Court -Port St. Lucie
_ , 19 , s~~d I reside at
(Streef and Number)
FORT PIERCE, SAINT LUCtE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Ho~ida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence and applying for homestead
FIl.EO ANO RECORDED'
- ST. ~UCIE COUNTY. FLA.
Ci!R^ ;•cRIFfFD
188560
'70 J~N 2 0 AM ~ p; p 0
~ w~~
~
' - ~
:'Q~~K ~•OiTR:,S
CLERK CIRCUIT COURT~
I FURTHER CHtTIFY that 1 will comply with al) other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SA(~~;~CIE COUNTY, FLORIDA, permanently.
_ .
_ ` : - J ~ ' ~
- , r _~.~/'~/,(1`D~.~~
~ ~ i~
f;•''~' , (Name~_
. ; ..~,~°'j~:~y;. ~s : Ellsworth K. Shinn
_ ' . ~ ~ - ~ `
,,a'• • . ~ ;
_ :4~ (A~d~MS)
~
~ 20th Januarg 70
Swo~n to and subscribed before me this day of , 19 .
~
ROGER rO1TRAS
CIRCUIT OURT . Notary Pubiic
o~-c,~~ ~4~Cc~v
By D.C. My Commission expires
(To b~ ~x~cut~d in dupliah and ori~ieal fil~d with Cle~k Circuit Cour~, and dupileaf~ with Tax A~or.)
aooK 18~ PAGE 103~
No. i 3
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