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Declaratio~ ot Domlcile and Citizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR~, 4
Sl. IUCIE COUNIY, FLORIDA:
This is my decla~ation of Oomicile and Citizenship in the Stbte of Flo~ida that I am filing this day in acoordante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Jackson Oh~O
(Ciry) (State)
and I ~esided at , at _ However 1 have changed my domiCile
(Streat and Number)
to and am and have been a bona fide resident of the State of Florida since 1st day of
ldav_____ ~9
64, and 1 reside at 14~ Dau3els Street - Whfte City
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the State of Horida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employmsnt
at former domicile, removal of family to new domicile, purchase of home, etc.)
o ~
Establishing residence and applying for home~tead
Fr! ED ~~JD RECORDtD '
, LU~,~ ~t~U~~y^rL,;-
~89528
9 p,M ~Z : 54
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~ ~inCU1T C~URT
I FURTHER CERTIFY that I wil) oomply with all other requirements of a legal reaident of thia State. ~
: FURTHER CERTIFY that I have no intention to retum to my former domiCile, and I intend to remain in FORY
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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J'' - Gr , (Name)
f~ ;
r,.~=~ o ; ~+,1=: Bill Hall -
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~~i.'~ 1jn, ~~•:'Q~~~•`~s`+~
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~ Swotn to,and~subscribed before me this 9th day of February ~ 19 ?0
R ER POITRAS
K CIRCUIT OURT Notary Public
,~-~J(.~~
By D.C. My Commission expires
(To b~ ~xecuted in dupliut~ s~d oripinal filed whh Cl~k Cinuit Court, and duplicah wifh Tax A~s*or.)
aooK 182 P~E23?3
- No. ! 3
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