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Oeclaration ot Domicils and Citisenshlp }
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TO THE STATE AND COUNTY TAX ASSESSOR, '
Si. lUC1E COUNTY, FLORIDA:
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This is my declaration of Uomicile and Citizenship in the State of Florida that I em filing thia day in acoordance and ~
in conformity with Chapter 222, Sectio~ 222.17, Florida Statutes. ~
Loa Aainas Colorado ~
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I was formerly a legal resident of ~S !
(CitY) (StaM) ~
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and I resided at 2 Ze 8 Ami2ie.~ , However I have chan~ed my domic3le
~ (Street and Numbe~)
to and am and have been a bona fide resident of the Stste of Florida since - Q~y of
.DL?'C2L - , 19~~, and I reside et Rt 2 BOZ 2998 I~kewOOd Pa7Ck
- (Street and Number)
FCRT PIERCE, SAINT LU~IE COUNT~', FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the Stab of Florida.
(Insert here any pertinent fads, such as sale of property o~ busi~eu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establiehing reeidence and epplying for homeeteed
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~'8 ANp~RF~
ST, WCtE CO~H~~„ -
RECORD VER~FrEp~"
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~lQ MAR 30 pM 1926p5
~~23
ROGER pUrTR^~
o~eRK c,RCViT co~
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~ I FURTHER CERTIFY that I wil) oomply with all other requiremenb of s leyal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to retum to my former icale, and 1 intend to ~e i T
~ PIERCE, SAIPRr~Ut~E ~(~JNTY, FLORIDA, permanently. - ~
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~ `~r • = R Clara B. Remling
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~ -~~~ta`bnd suburibed before me this 3gth day of ~erIIh 70
, . , 19 .
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~ ROGER POITR/?S
= CIRCUIT COURT Notsry Public
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BY C~ D.C. My Commis:ion expires
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n (To b~ ~x~cut~d in dupltut~ and o~pinal Bl~d wilh Cl~ek Graiif Cour~, •nd duplicah wi~h Tax A~.)
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~ aooK1~3 P~f2267 ~
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