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Declaration ot Oomicile ~nd Citisenship
:
TO THE STATE AND COUNTY TAX ASSESSOR, j
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Sl. lUC1E ~OUNTY, FIORIDA: ~
This is my declaration of Oomicile and Citi=er~ship in the Sfate of Flaida that I am filing this day in aaordance and
~n m~formity with Chapter 22~, Section 222.17, Fiorida Ste~f~7tes.
I was formerly a Jegal reside~t of JohnatQn C1t~ N@w York
(Ciry) - (State)
and 1 resided at _ _36 H8yII88 AVe. , Flowever I have changed my domicjle
. (Street end Number) .
to and am_ anci have been a bona fide resident of the State of Florida since 2nd day of
• Februar~ 19 69 109 w Prima Vista Blvd,
, , and I reside at
(Sireet and Number)
PORT PIERCE, SAINT LUCIE GOUNTY, FLORIDA -
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- - - -
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Horida.
(Insert here any peninenl fads, such as sale of property or busineu, or relinquishme~t of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
Establiahi3~g residence a.nd applying for homestead
0
pc~o REt~~Y~~
FILE~ `E COV : tED~~
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I FURTHfR CERTIFY thst t wifl oomply with all other requirements of a(eflal resident of this State.
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; t FURTHER CERTIFY that t have no intention to retum to my former domicile, and I intend to remain in FORT
PIERC~, SA! ~t.1yvy~!E"~COUNTY, FLORIDA, permanently.
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- •~..jy Q~`~±- (Name)
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_ ; _ `w=~. r.,::~r Theresa xeeeer ( l~[ra Joseph )
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Swo~n to and subscribed before me this 19th day of ~ February i9 70
,
ROGER POtTRAS
K tIRCU1T COURT Notary Public •
` a~..~.~!'~' L~ '
; 8 ~.C. My Commisaion expi~es
; (To bs ~xecuted in dvpliaf~ and originsl fit~d wit1~ q~rk Cirwit Court, and dupiiph witb Tax Ass~ssora !
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' aooK 183 81
No. 13 . t
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