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Declaratio~ ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. WCIE COUNTY, FIORtDA:
This is my declaration of Domicile a~d Citizenship in the State of Florida that 1 am filinfl this day in accordance and
~n confo~mity with Chapter 222, Section 222.17, Florids Statutes.
1 was fo~merly a tegal rosident of StNSri IiBkB New York
(City) ($tste)
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and 1 resided at ROLlte - However I have changed my domitile
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since _____~th--__ day of
- ---_-_-AugUlst____-----. 1970_, and I reside at 3429 Carlyle St.
(Street and Number)
FORT ~IERCE, SAINT LUCIE COUNTY, FIORIDA
and this statement is to be taken as my declaration of citizenship, act~al legal residence and domicile i~ the State of Florida.
(Insert here afly pertine~t 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.) _
(Homestead Eaemption)
- 201052
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REOORp VERIPlEO
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~ 1 RIRTHER CERTIFY that I will oomply with atl other requirements of a leya) resident of this State.
I FURTHER CERTIFY that 1 have no intention to ~eturn to my former domicjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, pe~manently. R1t8 C8t erine ~Towneend ~1~T8. Floyd)
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Sworn to and subscribed before me this 17th day of November ~ 19 .70
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V ~ ~ C ~ ~ Notary Public
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ey = ' ~ D.C. My Commission expires
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l~1 . ~wlupliut~ snd ori~inal ~il~d wftb tlKlc q~if f.ouet, ~nd dupliaat~ with Tax A~s~aaor.)
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r::~t~t~ BOOK 11~U PAGE t7~~
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