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Declaratio~ ot aomicile and Citisenship
TO THE SiATE AND CDUNTY TAX ASSESSOR,
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapter 22?, Section ???.17, Florida Statutes. ~
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I was formerly a legal ~es~de~r of _ Bergenfield _ rZew_ ~er~__
(City) (State)
237 Bradle Ave. 9 y :
and I resided at _ y_ However I have chan ed m domicjle
(Street a~d Number) ;
i
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to and am and have been a bona fide resider~t of the State of Florida since _ ls_t _ day of ~
CCt , 19__?~, and I reside at _ 413 W1ilOY13 Ave.
_ _ -
(Street and P~umber)
FORT PIERCE, SAINT LtiCIE COUNTY, FLORIDA
and this stateme~t is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of propery or business, or :elinquishment of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.) ~
i
(Homestead Exemp~ion)
'F~~O'ANO`RECOROEbl
. ST.R
UC~1 Rn VuRTF1E0LA~
199291
'70 OCt S ~ ~ ~ ~ ~
~
~ ROGER POITRAS
, CI.ERK ClRCUIT COURT~
E
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it
S
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~ I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
~ I FURTHER CERTIFY that 1 have no intention to retu~n to my former domicjle, and I intend to remain in FORT
~ PIE~CCE, SAINT LUCIE COUNTY, FLORIDA, permanently. RLiBSeli W. Andrews
~
~ x _ 7l>.-
~ (Name)
~
~
~ (Address)
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~ Sworn to and suburibed before me this 5th day of Oetober ~ i9 70
~ .
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~ ~.~i`=t:.~' -
/
~QLi~lt. ~ %
,
~ "~~'G1kElJlt, ~ Notary Public
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By . D.C. My Commission expires
• . t-. .
Re~ bi'~~wsvN~'M~duplicat~ snd originsl fil~d wfth CIKk Circuit ~ourt, and duplisst~ with Tax Ass~ssor.) -
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