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Oeclaration of Dor~icile and Citisenship
70 THE STATE AN~ COUNTY TAX ASSESSOR, ,
Sl. LUCIE COUNTY, FLORIOA:
This is my declaration of Domicile and Citizenship in the State of Flo~ida that I am filing this day in accordancs and
~n co~fo~mity with Chapter 222, Section 222.i7, Flo~ida Statutes.
1 wns formerly a legai resident of JeTSey City New Jersey
• (Ciy) (State)
and 1 ~esided at 52 Carr Place I''OY'ge N. .T. , However 1 have chaRged my domitjte i
.
(Street and Number) a
to and am and have been a bona f+de resident of the State oi Florida since 28th day of
Ro Fed. Hi-wey
September ,~969 , and 1 reside ar Ridgecrest Trailor Court 8~
(Street and Number) ,
FORT PIERCE, SAIN? LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaratior~ of citizenship, actuat legal residerice and domicile in the State of Horida.
(Inse~t here any pertinent facts, such as sale of propery or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
:
Establishing residence end applying for homestead
FILEO ANp RECORDEp ~
ST. LUCi~ COUNTY, Fla.
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C?FCt,tr7 COURT.
I FURTHER CERTIFY that 1 will oomply with all other requirements of a(egal'resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to my former domitile, and I intend to remain in fOR7
~ PIERCE, SAINT LIjCIE COt1NTY, FLORIDA, permanently.
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_ ' - t (Name)
. -
- ~ ~ Rose Woolland
,
.
, . ' : (Address) j
-
Sworn to and subsc~ibed before me ti~is 9th day of Idareh ~ ~q 70
ROGER POITRAS s
,
RK CIRCUlT OURT - Notary Public ;
,
ey D.C. My Commiuion expires ~
7
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(To be executed io duplicate and origir~al fil~d with Gerk Grwit Court, se~d duplicats with Yax Asiessor.)
B ~OK 183 P~~ 12~1
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