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V
DeClaration of Domiclle and Citizenship
TO THE STATE AND COUNTY TAX AS~ESSOR,
Sl. lUC1E COUNTY, FIORIDA: ~~~~(~2
This is my declaration of Dom~cile and Citizenship in the State of Florida that I am filing this day in accordance and j
~n conformity with Chapter 222, Section 222.17, Florida Statutes. ~
~
I was formerly a legal resident of N~w York ___Nsw York
- - (City) - - - - - -
and 1 resided at 8a""25 250 Stl~ee~ B~llerose ~ N• Y~ _ However I have changec~ my domiule
(Street a~d Number)
October 9
to and am and have been a bona fide resident of the State of Florida since . day ot
19 T~ , and I reside at 151 flat~y~a. Dri~e Por~ 3t I.oeie
(Street and Number)
FORT PIERGE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my decla~ation of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of family to new domicife, purchase of home, etc.)• -
John Ja~ and Dennis K. A~ilea
FIl.EO ANa RECOROEO
5?. WC~E COUNTv:_FL~.
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19~32~2
, r ~NI 1t:12 ~
10 0 ~j 5 ~a
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~;c,,:;~; ~ ~ oizRas
CL~RK C?RCUIT COURT
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~ 1 FURTHER CH2TIFY that 1 will comply with all other requirements of a(egal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
t
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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(Name) ,To A~ile•
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:.Y " ' _ _ . _
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~ - (Address)
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~ ~ Sworn to a~d iuburibed before me this 5 day of -~ato~r ~ 19 70
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~ ROOER • -
. Cl6R1(,
tIRCU1T UR ~ Notary Public
.
~ ~
By ~ - ~ l~~ _ D.C. My Commission expires
(To b~ ax~cut~cl in duplicat~ and ori~inal ~il~d vrith Cl~rk Circuit Cou~f, and dupliut~ wfth Tax Ass~ssor.)
a~ox187 PA6E1396
No. 13