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Declaration ot Domicfle and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in acco~dance and
in confo~mity with Chapte~ 222, Section 222.17, Florida Statutes. i
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I was formerly a legal resident of _ _ _ _ p~ ~?~hing~n_ _ _ _ _ _ _ _~~t~~ I
(City) (State) ~
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and 1 resided at _ b8 Bl~ohwood A~enw . Howeve~ 1 have changed my domi~ile
~ (Street and Number)
to and am and have been a bona fide ~esident of the State of Florida since ..J~_ 2_ day of
19~D_, and I reside at .~QB NS Lobate~c BQad -
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(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA P°~ ~t Lneie
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicite in the State of Florida.
(Insert here aRy pertinent facts, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
8stablio6ing residenoy and iilin~ !or hooeste~?d e:eaption ~
- PIlEO AND RE~p~~ ~ i
iT.lVC1E COUII~r f1~
~ ROCER t01TRA=
~LERR CIRCUIT QO~T~~.
- RECORO YERIf1E0~~..~'
~ ~ S iz ~ n~'16
. ~ 2C 0569
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1 FURTHER CERTIFY that I will comply with all othe~ requirements of a leflal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domitile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~M:~i~~~r~ r= (Name) Al!=^td B~ Howan
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f ' ibed before me this atb day of No~b~r , ~q 70 ,
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ROGER rORRAS
CLERK CIRCUR URT Notary Public
B 7~Drf'
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y D.C. My Comm~ssion expires
(Te b~ rx~cubd ie dupUcab and oei~inal Al~d wNh Cl~rlc Cirark Ca+~f, and dvplie~fs wifh Tuc At~a~.)
„ aQO~ ~$8 PACE ~93
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