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Declaration ot Domicile and Citizenship ~
,
. 8$~~3
TO TNE STATE AND COUNTY TAX ASSESSOR,
ST. IUCIE COUNTY. FlOR1~A:
This is my declaration of Domicile ar~d Citizenship in the Stste of Florida that I am filinq this day in aooordanos and
i~ oonformity with Chapter 22Z. Section 222.17, Fiorida Statutes.
1 was formerly a legal rosident of wil~nington New YorY
~ (City) (~a~)
and 1 ~esided st ~i~ Street . Hov,rover 1 have changed my domiCile
(Street and Numbe~)
to end em and have been a bons fide resident of tJ~e State of Ftwida sinos 1St day of
November 69 401 H ernando Ave. (Pt. Pierce Beacb)
19 , and 1 ~ide at
~ (Street a~d Number)
FORT PtERCE, SAINT LUCIE COUNTI~, RORIDA
and this statement is to be taken as my declaration of citizenship, sctuai legal ~esidence and domicile in ths State of Horida.
(Insert here any pertinent facts, :uch as sale of property or business, or relinquishment of employment
• st former domicils, romoval of family to ~sw domicile, purchase of home, etc.)
Bstabiishing residence
. ~
i
FILEO AND RECORDED
~ ST, LUCIE COUNTY. Ff?L~:.
~ ,.I.V~r ,Y^F~~'~~1/
188~63
'ZO JA!~ 20 AM IL~ : 42~
-~c„pY` • .
~•~?fTR:,S
CLERK CiRCUIT COURT
I RIRTHER CERTIFY that 1 will oomply with all other requirements of a legal ~esident of this State.
1 FURTHER CERTIFY that I have no intention to retum to my former domicjle, and 1 intend to remain i~ FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, petmanently. .
,~:,:t~' '!ir..,., ~
-~j1.'
~ , (Name)
T - . ' - Os~a . Senn
~ ` Y. : • ~r ' n .
_ \ L ~
V-
. .
~ . • ''!i~•~' ~ Ruth A. Se~n~
-
.
. j. I ^ v`~~ ~i~~~ : :
Swor`ir~a ~and subscribed before me this 20th day of J~uiry ~ 19 70,
ROGER POITRAS
K CIRCUIT COURT Notary Publk
8y °"'~`.c'~. ~ O.C. My Gommiuion expi~es
. ~
;
(To b~ ~x~cut~d ie dupliut~ and ori~Inal fil~d wilh CI~?ic Ckwit Couh, ~nd dupliub with 1ax Ass~swra ~ E
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