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Deciaration ot Domicile a~d Citizen~hip ~
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FtORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and ~
in conform+ty with Chapter 222, Section 222.17, Florida Statutes. 's
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I was formerly a legal resident of Nor+nal__ I11 ~
(City) (State) ~
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and 1 resided at _~82.___ _ However I have changed my domiCile ~
(Street and Number) ;
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to and am and have been a bona fide resident of the State of Florida since -~~.st~__ day of '
19
69 , and 1 reside at . R R 1. Box 885 ~
(Street and Numbe~) ~
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domitile 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, etc.)
Filing for houeetead ezemption
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F~~ E~ ;..r~U RECORDEC
; ~T. L"CE~ ,.~U•~TY, F~
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S:c,~. 12 w~i ° : 43
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1 FURTHER CERTIFY that 1 will comply with all ~ther requirements of a legal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNN, FLORIDA, permanently. F
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~ _ (Name) D el ltiller 3
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~ (Address)
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~ Swom to and subscribed before me this 12 m day of Febrnary ~ 19 70
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ROOER POITRAS
CLERK CIRCUIT COURT Notary Public
rs By ~ D.C. My Gommission expires
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r; ~Te _bii -~x~outed in duplicate and originsl filsd with Cl~rk Grcuif Courf, and duplicab with Tax Ass~ssor.)
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