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Declaration of Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. IUCIE COUNTY, FLORIDA:
This is my decla~ation of Domicile and Citizenship in the State of Floridb that 1 am filing this day in accordance a~d
in conformity with Chapter 222, Section 222.17, Florida Ststutes.
1 was formerly a legal resident of Bilt lmOr! (~110 _
(City) (State)
and I resided at - RpD However I have changed my domitile
(St~eet and Number)
to and am and have been a bona fide resident of the State of Florida since day of
_ , t9
69 , and I reside at 4v0 Sandi• Dri~e
(Street and Number)
FORT PIERCE, SAINT LUCIE GOUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(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.)
Piliog for hosestead exeoptioo
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F~LED AND RECORQED ~
ST. LUCIE COUPJTY. FLA.
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1885`71 .
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1 FURTHER CERTIFY tfiat I will comply with al) other requirements of a lega) resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
'C~~%Ci1.60
. Name) NaoCy D. Rpberts
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(Address)
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~ ~ • Swoin to and subscribed before me this day of Jinuary ' , 19 70
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~ ' kOGEIt ; E!OITRAS
~ ~ ~K EUtCU1T COURT Notary Public
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~ 8y• ~ . 't ' D.C. My Commission expires
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(To b~ execurod in dupltuh snd ori~inal filed with Cleelc Circuit Court, and duplicat~ wHh Tax Ass~ssor,)
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