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Declaration ot Domfcite and Citizenship
TO THE STATE ANO COUNTY TAX ASSESSOR, • ~
ST, IUCiE COUNTY, FIORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filinq thi: day in aooord~na and
in oonfo~mity with ~hapte~ 222. Section 222.17, Florida Statutes. ,
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I was formerly a legal ~esident of ~~lteweZ Tenn.
(City) • (Stats)
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end I ~esided at Rt . 3 BOR 148 , However 1 have chsn~ed my domitjle ~
(Street and Number)
to end am s~d have b~en a bona fide resident of tha Stete of Florida :inoe ~ st ~ - day of !
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February , 19 ~~6~~ at 303 N. 31th St.
(Street and Number)
PORT PIERCE, SAIN? LUCIE COUNTY, FLORIDA ~
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Stab of Horida.
pnsert here any pertinent fatts, such a: sale of property or business, or relinquishmen~ of emplayment
at former domicile, removal of family to new domicile, purchsss of home, ttc.)
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(Homestead Eaemption)
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FII.ED AND RECORDED
__ST. LUCIE COUNTY. FLA.
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. '70 t~3AR 4 AM i I: I 7 •
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~~Ui:i_~? ^~~7n:.S
C~fRK CIRCUIT COURT.
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~ 1 FURTHER CERTIFY that I will oomply with a!I other requirements of a Isgal restdent of this State. !
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I FURTHER CERTIFY that 1 have no intention to ~etum to my forme~ domitile, snd 1 intend to remain in FORT
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PIERCE, SAINT LUCIE COtJNTY, FLORIDA, pe~msnentfy. 0. E. VV llisIDS f
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~ (Name)
~ 303 N. 31th St. -
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~ (Add~ess)
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~ "•~S'vp~~~6,and subsuibed before me this 4th day of ~IarCh_ 19 70• ~
4 ;1;.•:,;sl~; ~ i
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~ . • ~it ~OITRAS
• I~CUIT COURT Notary Public
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~ D.C. My Commiuion expires
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~ (To b..x.cu?.d in duplicaa and oriainal ~I.d with CI•rk Cinuit Cou~, and duplic~~ witb Tax As~asora
~ . 800K 183 PACE 9~6 ` ~
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