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Declaration ot Domicile and Citize~ahlp
TO THE STATE AND COUNTY TAX ASSESSAR, ;
51. LUCIE COUNTY, FLORI~A:
This is my deciaration of Dom~cile and Citizenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of AlexBridriB _ ~1Pg1A~8 t
(City) (State)
and 1 resided at 35 ~$st Taylor Rwn PaTlcvvBy However I have changed my domitile
(Street and Number)
ro and am and have been a bona fide resident of the State of Florida since 5 th _ day of
September 70 124 Zucero Drive PortSt. Lucie
_ , 19__ , and 1 reside at - _ _ . - - -
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FIORIDA .
and this stateme~t is to be taken as my declaration ot citizenship, actual legal residence and domicile in ths State of Flarida.
(Insert here any pertinent facts, such as sale of property or business, cr retinquishment of empioyment
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
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Establishing residence and applying for homestead
fILEO ANO RECORp
sT. LtW1E COUN?Y F
NOCER POITRAi
CLERK CIRCUIT COIMT
RECOltC VERIFIEO.~~•~
OCT ZB I: 04 ~H
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20030'~
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
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~ 1 FURTHER CERTIEY that I have no intentior~ to return to my former domiCile, and 1 intend to remain in FORT ~
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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2 ' i .4
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~ Richard J. Downey-
. ~4,t~.~i..a. ~e~..p--yt..Q. ~
~ - . ,~.•~i.;' ~~ss) ~
~ , ~ar~ha S. DoWney ~
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~ ~ ~ 28th October
~ ~ Swotlt°t~~and subscribed before me this _ day of - , 19 70 .
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~ RO~GER POITRAS _ _
CIRCUIT C RT Notary Public
~ ~~•c~i ~4`{-~L-IX/t~
By - D.C. My Commission expires
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(To b~ ~x~cufa! in dupliut~ and ariqinal fil~d with Clt~lc Grcuit Court, and dupliut~ with Tax Ass~ssor.)
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