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, Declaration ot Domicile and Citizenship E
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA: '
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This is my declaration of Domicile and Citizenship in the State of F!orida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of _~~ten I~ HeW York _
(City) (State)
and I resided at ___-~1_ O~GOZ'ID821 AV9. However I havechanged my domicile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since JU11e 23 _ day of
, 1969 , and I reside at Route 2~ BOY 3044 `
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this~ tatement 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 busi~ess, or relinquishment of employment
;
at former domicile, removal of family to new domicile, purchase of home, etc.)
Filing for homestead exemption
F~~E~ ~4ND RECOROED
ST. LUCIE COUtJTY. FLA. ~
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i Cl~'RK CIRC(,'1T COURT
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~ 1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ . (Name) John Keleman
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~ Swo~t1 to_and subscribeci befo~e me this 2? day of J~~Ty ~ 19 ?0
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~ :~Q~i~f~t: ~OITRAS
_ . ~LLRIC CIRCUIT COURT Notary Public
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~ By ~ D.C. My Commission expires
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(To be executed in duplicate and originsl ~iled with Cl~rk Circuif Courf, snd duplicah with Tax Ass~ssor.)
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