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~eciaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Si . LUCIE COUNTY, FIORIDA:
This is my declarotion of Oomicile and Gitizenship in the State of Florida that 1 am filing this day in aoo~rdance a~d
in conformity with Chapter 222, Section 222.17, Florida Statutes.
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I was formerly a legal resident of Y1~i . F18.
(City) (State)
and 1 resided at ___~.44~~•~ • 102 COLtTt However 1 have changed my domic.ile
(Sfreet and Numbe~)
to and am and have been a bo~a fide resident of the State of Florida sinte 20th day of
_____._dul„o , 19~2, and I reside at 865 Feetlv0 Couz~t~ 2~.Pt. St. I,uCio
(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 ire the State of Horida. ~
(Insert here any pertinent fatts, such as sale of property or business, or relinquishment of employment
at former domicile;~ removal of famity to new domicile, purchase of home, etc.)
FILED AND RECORDEp~ !
, ST. LUCIE COUNT ED~A. !
Residence ~899 `jEK~Fr' i
69 t
~ro FEa i 1 '
~ ~~:21 • ~
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, ~~-~RK CIRCUIT COURT.'
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I FURTHER CERTIFY that 1 will oomply with all othar requirements of a legal resident of fhis State.
1 FURTHER CERTIFY that I have no intention to retum to my former domiti~e, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~ GL~~~)
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(Ner+nej--'-
_ . (Mre. Barton T. Beewick)
" ~ 865 Feativo Court, Pt. St. Zucie
_ ,~~i~~~LU~it ji~lj!!
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r ~~~r~i~ ;i'-j~ 1
- ~ 17 February TO
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f. dtxf;io$scribed before me this te~ day of , 19 .
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~ -i`AURT Notary Public
By ,Jf . v~~~~~~ j. ~ D.C. My Commission expires
(To b~ ~xecut~d in dupliut~ and oripinal fil~d with Clak Cirwit Court, and duplicat~ with Tax Afs~s~or.)
BOOK 182 PA~293~
`y No. 13
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