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~ Declaration ot Domicile a~d Citize~ship ' '
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TO TNE STATE AND COUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FLORIDA:
This is my declaration of Uomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conformity with Chapter 222, Section 222.27, Flo~ida Statutes.
I was formerly a legal resident of -_-_Del"O Beach Fla .
(City) (State)
and I resided at _ 2346 GT8ri8de Ave . However 1 have changed my domic.i~e
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _-?~t2i day of
_ November 19 69 , and I~eside ar Rt 2 Box 2763-20 Lakewood Park _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or husiness, or ~elinquishment of employment
at forme? domicile, removal of family to ~ew domicile, purchase of home, etc.)
Establishing residence and applying for homestead
FIl.ED ,~/1~ ~p
ST. LJCIC ~ U~
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° I FURTHER GERTIFY that I will comp
y w
-al) other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permane~tly. •
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~ - ~ . ~ Sally Zieberman (~lrs Richard)
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Sworn to and subscribed before me this 3rd day of March ~ 19 ~0
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ROGER POITRAS
CIRCUIT OURT Notary Public
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By D.C. My Commission expires ~
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(To bs executed in duplicaM and originsl ~iled with Clerk Grcuit Court, and dupliut~ witl~ Tax Ass~ssor.)
_ / BOOK 183 PACE OJV
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