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Declaration ot Domicile a~d Citize~ship
TO THE STATE AND ~OUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORI~A: ~
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This is my declaration of Domicile and Citi=enship in the State of Florida that I am filing this day in atcordanoe and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
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1 was fo~merly a legal resident of '~~r i~~ "a
(Ciy) (Staro)
and I resided st 1716 Overlook Dri ve . Nowever 1 have changed my domidle
(Street and Number)
b and am and have been a bona fide resident of the State of Florida since ~iuly 4 day of
, 19fl9-, and I ~eside at ?`~Q~ g~.~~.~~~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, attual legat residence and domicile in the State of Ho~ida.
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(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Filing_ for homestead eaemption
FlLED ~~JII RECORDED
L'JCi= C~Ut:TY. ~L.~.
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190`72~
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~ , . :,L~Rti' ~~r :;;iT ~OURT
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~ I FURTHER CfRT1FY that I will oomply with all other requiremants of a(e~al resident of thi: State. ~
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, permanently. .
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~ (Name) !
~ rray E. ~orse ?
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~ S?worn to and subscribed before me this 5th day of ~rch ~ 19 ? ,
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t~ ~~'C~RCWT COURT Notary F'ublic Ei
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y~ ` D.C. My Commiuion expires ~
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(To !1i ~x~cut~d in dupliut~ and oripinal filsd witl~ q~k GreuH Couvt, and dupliut~ with Tax Ass~or.)
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j~ ~ g~183 P~1055
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