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Oeclaration oi Doeniciie and Citizanshlp
TO TNE STATE AND COUNTY TAX ASSESSOR, '
51. lUC1E COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship i~ the Stete of Florida that 1 am filing this day in actordance and ~
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~n conformity Mrith Chapter ?22, Section 22?.17, Florida Sletutes.
I was formerl a 1 al resident of !.tuiAC b:888.
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(City) (State)
and i ~esided at _60 SOYlOIDB Rd. ` However 1 have changed my domiGlc t
~ (Street and Number) '
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to and am and have been a bona fide ~esident of the State of Florida since _____22nd _ day of
~pril__ , ~q ?0 , and ~ res;de a~ 2601 Oleander Ave . _
(Street and Numkser)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, aciual 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 former domicile, removal of family to new domicile, purchase af home, etc.)
- (Homestead Egemption)
_ 2Q0858
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1 RJRTHER CHiTIFY that 1 will comply with al) other requirements of a leflal resident of this State.
I FURTHER CERTIFY that I have no intention to refurn to my former domiGle, and I intend to remain in FOR7
; PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. W111~ C. llfs
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(Name)
(Address)
Swarn to ~~~bscribtd before me this 13th day of - IrOVembeZ' ~ 19 70
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' % ~ Notary Public
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8Y ' D.C. My Commission expires
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lTO , ~IIJ Ofi~MI AI~II W~fll CIMII GKY~f COYf1~ aed dupliut~ w~ti~ Tax Ass~ssor.)
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' ° eooK 1~$ ?~a~E 61U
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