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Declaration ot Domicile a~d Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. lUC1E COUNTY, FIORIDA:
This is my declaralion of Domicile aRd Citizenship in th~ State of Florida that 1 am fili~g this day in accordante and
~n conformity with Chapter 224, Section 222.17, Florida Statutes.
I was formerly a legal resident of Bloomfield ~@W Jeraey :
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(City) (State) '
85 Flo d Avenue
and I resided at ~ _ _ _ _ _ However 1 have changed my domic,ile
(Strest and Number)
ro and am and have been a bor.a fide resident of the State of Flarida since l~t _ day of -
Rt. ~2, Bo= 3645 3
_4~tobex~ , 19_7~ , and I reside at _ SBiIIt IrL1C1e lvenue, ~
LABEWOOD PARgm~~ • Pierc e, Fla. ~
FORT PtERCE, SAINT LUClE GOUNTY, FLORIDA ~
and this statement 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 property or business, or relinquishment of employment i
at former domicile, removal of family to new domicile, purchase of home, etc.)
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Hamestesd
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FIIED AND RECORDEO'
ST. LUCIE COUNTY. FLA,
a~~OPD V=RIr'F~'
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'T~ OCt S AM I I E S 8
6i--
ROGER ~ OfTRA
CLERK CIRCUIT COURT' ?
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~ t FURTHER CERTIFY that I will comply with all other requirements of a leyal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT lUC1E C~JUNTY, FLORIDA, permanently. %!r`" /
W ILLIAM 1~ JUDSON ~ ~
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~ (Name)
~ 8T. # 2, Boz 3645, I,akewood Park
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' (Address) Ft. Pierce, Fla.
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~ - " 5th October ~
~ Sworn~~o and~`~ubscribed before me this day of _ , 19~_.
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~ ' '~1~~ COURT Notary Public ~
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gy ~ D.C. My Commission expires
(Yo b~ ~x~cut~d in dupliut~ snd oripioal ~iled with C{~rk Grcuit Court, and dupliu» with Tax Ass~ssor.) ~
BOOr,10 / 14~~. s
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