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Dectaration ot Domicile a~d Citizenship
TO THE STATE AND ~OUlVTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of ~omicile and Citizenship in the State of flo~ids that I am filing this day in auordance and ~
~n conformity with Chapte~ 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of Mt. Ephrein NeW Jer8ey
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and I ~esided at _ 3 ~ 4 LakefT021t , However I have thanged my domicjle
{~sreet acx! Nu?nls~r) ~
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to and am and have been a bona fide resident of the State of Florida since 3rd day of i
2 02 T~H~~$i Tamarind ~
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. August , 19 69 , and I reside at ~
(StreM and Number) ~
FORT PIERCE, SAINT LUCIE COUNTY, 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 Ho~ida. #
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(Inse~t here any periinent facts, such as sale of property or business, ot relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, ett.)
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; (Homesteed Exemption)
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FILED AND RECOROED'
ST. LUClE COUNTY. FLA.
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'70 t,~l', ~ Q QM f~ ; ~ ~
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~ CLERK .C;RCJJT COURT
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I FURTHER CERTIFY that I witf oomply with all other requirements of a legal'resident of this Stats.
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I fURTHER CERTIFY that 1 have no intention to retum to my former domivle, and 1 intend to remain in FORT _
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. Su8e21 Al,b.inson (~t'S. John E. ~
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(Address) F
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and subsuibed before me this ~ Oth day of MsrCh ~q 70 , !
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~ a IRCI~I~; COyR ~ . Notary Public
~ ..~u: 5 _ M Commission ex ires
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~ (To 'b~ ixecuted in duplicate and origi~ul filed with Ger~k Cirwit Court, and duplicats with ?ax Assvssor.) ;
~ ° ~ ~.83 1 `
~ BOOK Pkf,E 352 ~
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