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Declaration o~ Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day i~ aoo~rdance and
,
in conformity with Chapter 222, Section 222.17, Florida Statutes. ?
I was formerly a legal resident of Darien ConxleCtiCUt
(Ciy) (State)
and 1 ~es~ded at _ 17 Oake Park Avenue _ _ -
. However 1 have changed my domi4le
(Street and Number)
b and am and have been a bona fide resident of the State of Florida since Jul3~ 1 day of
,~9
69 , and 1 reside at 4~11 Sunriae B1Vd.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, aORIDA
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 facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, ettc.)
I~iling ~ ~r homestead ezemption
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FILED AND RECOROEO' ~
ST. LUCIE COUNTY: FLA.- ~
i P.~CORC V~RIFlED ~ '
' ssg,r,~y
'70 JAN 20 ~A !Z : S7
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, :?e~~~ ~'OITR..s~`
CLERK CIRCUIT COUR7;
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1 RJRTHER CERTIFY that I will oomply with al) other requirements of a lega) resident of this State. ~
1 FURTHER CERTIFY that I have no intention to return to my forrner domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA~ permanently.
' L? - ~ . M- .~c.a.~
. (Name) Herbert . D. l[ayers
(Address) _ _ ,
1 j~
_ - ~
$worn to and~'si~bscribed before me this 20 day of 'j~ua~ , 19 70. f
~ : -
. ROGER ~S.'
'~.:-.,._jx~ER~F,~1~~I COU T Notary Public
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By D.C. My Commission expi~ea
(To b~ executad in duplluh snd original filed wkh El~elc Grcuit Court, and dupliut~ witl~ Tax As~ssor.)
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