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Declaration ot Dort~iCile and Citizenship ;
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORI~A:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
$OI~C I~l l le
I was formerly a legal resident of - s~~==zY~ _ ~ss' -
(City) (State)
and 1 resided at ~s5 put~~ Stt@et ~Wever I have changed my domitile ~
(Streef and i~lumber)
to and am and have been a bona fide resident of the State of Florida since _ ~t01Ct 28 day of
,~q
69 , and I~es~de ai 131 Castana Court
(Street a~d Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of.Florida.
(Insert here any pertinent fads, such as sale of praperty or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Piling for homestead exemption ,l~
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I FURTHER CERTIFY that 1 will comply with all other requirements of a leyal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my form~r domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, fLORIDA, permanently.
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~ (Name wrence J Heenan
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3 . / 3/ ~'~to~~ . -te ;
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~ _Sworn to~and~.sutiscribed before me this 23 day of -Ta~Varjf , 19.~Q.
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~ ~•rtoo~at: Porie~?s
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~~11T COURT Notary Public
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~ By D.C. My Commission expires
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~ (To bs sxecuted in dupliwte snd original filed with q~~lc Grcuit Cour~, sed dupliut~ with Tax Ass~s~or.)
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~ 600X~~2 PAGE~c~IhJ
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No. 13
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