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Declaration of Domicile and Citizenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, tt
!
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
im m~fo~mity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal res~de~r of Lexington Ohio _
(City) (State)
and 1 resided at ________Rt. 8 44990 However 1 have changed my domicjle
(Street and Number)
to and am and have been a bona fide resident of the State of Florida sinte _ 13 th day of
_ AugList_____ , 1969 , and 1 reside at ~ 4910 Elm Ave.
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, fLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Ho~ida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
;
at former domicile, remova) of family to new domicile, purchase of home, etc.)
0
(Homestead Examption)
_ FiLEU AND RECapn~~
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Y, FLa
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~ 1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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1 fURTHER CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. TheodOY'e P. Swingle ~
~
~ ,~:~~::estt~n~i~, ~ Name
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a ~~~~~~<:~,~,'r Q
~ -~~f~~i~.L. • • : ~ ~ 4 71~ Elm pve •
~ a~ `c (Address) ~
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12th
~ ~{~^.r .~~~$Wq~~ '`~~ubscribed before me this day of February ~ 19 70 ;
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~ ' ~!i{~rfi'..ity 5-,~'~.~' • 1
~ 1711st~31{N
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; CUIT COURT Notary Public
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By ~ D.C. My Commission expires
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~ Cfo be sxecuted in dupliute snd originsl ~ilsd whh CINk Clrwit Court, and dupliah with Tax Ass~s~or.~
~ BOOK 1~~ Pa~E~656
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