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Declaration ot Domicile and Cia=zenship
TO THE STATE ANU COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and ~itizenship in the State of Florida that I am filing this day in accordante and
~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes.
1 was formerly a legal resident of H~attsville Mar~~land
(City) (State)
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and I ~esided at ~ 900 ChapmBTl Rd . . Howeve~ 1 have thanged my domiCile
(St~eet and Number)
to and am anr! have been a bona fide resident of the State of Florida s~~ce _ 23rd day of
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April _ ,~q 69 , and I res~de a~ 504 ~Aayflower Lane ~
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(Street and Number) ;
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ~ '
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and this statement is to be taken as my declaration of citizenship, actua~ legal residence and domicile in the State of Florida. ±
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(Insert he~e any pertinent facis, such as sale of property or business, or retinquishment of employment '
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at former domicile, removal of family to new domicile, purchase of home, etc.) ;
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(Homestead Exemption) -
FILED AND R~COROED
ST. LUCIE COUNTY. FLA.
~~-.^nFC ~r~.RIF!ED
! 1912~
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~ . 'ZO t~t 20 PM !2: 23
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~ FOG~? ~ O+TRAS
~ CLERK CIRCUIT COURT
I FURTHER CERTIFY that 1 will oomply with all ofher requiremenis of a legal resident of this State.
1 fURTHER CERTIFY that I have no intention to return to my former domitile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. Betty BucklaYtd ~
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~ (Name)
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~ 504 'fayflower Lane
~ (Address)
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~ ~ 20th March 70.
~ Sworn to and subxribed before me this day of . 19
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~ ~Rt3~ER~d1'~~~
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~ _ Nota Public
~ cC~ - RCUt~'I~Q9RT ry
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~ g O.C. My Commission expires
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~ (Ybr; y, j. ~cu,ted in'duplipta and original filed with Gerk Circuif Couirt, snd duplicate with Tax Asseuor.) ~
~ ~R1~3 1~~? ~
600K PAGt ~
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