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D~eclaratlo~ of Domiclle ~nd Citiz~nshlp ;
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TO THE STATE AND COUNTY TAX ASSESSOR. ~ ~
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Sl. lUC1E COUNTY, FIORiDA:
This ~s my detlerstion of Domicile and Citizenship in the Stste of Florida that I am filiny this day in accordante and
canfo~mity with Chapter 222, Section 222.17, Flo~ide Stetutes. ~
~p ~ i CO LO RdDO
I wss formerly a legal ~esident of - - - - - - - - - - -
(~;ty) (Stat~)
42 North Peact~ Street
and I resided et - _ - - However I have chanfled my domitile
(St~eet ar~d Number)
ro and am and hsve been a bona fide resident of the Stste of Florida since Fourteenth _ dey of
.~'@ bZ'I,IATy - - - - 19
67 , and I reside at - - . .
- - - (Street and Number)
FORT MERCE, SAINT LUCIE COUNTY, RORIOA
and this statement is to be taken as my declaration of citizenship, actual Itgal reside~ce and domicile in the State of Flo~ida.
(Insert he~e any pertinent fads, such as sale of property or business, or reli~quishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
I have been on active military duty since July 1956 and do not presently
orzn a home in the United States; however, I have purchased property (I.ots
'7 and 28, ~lock 71, In~ian River Estates and Zots 22 and 23, Block 214?
Fort b~alabar, Florida) in ~ne atate of Florida and fully intend to reside
in rlorida ueon mf retirem,ent from the military.
I bou~ht a hoi::e in Colorado in 1964; however, I sold ~.re hone in 1965 and
at t~e oresent ~i~e own no propert3• in Colorado and only declare that State }
:is ~:y sailin; address due to ny mother living in Fruita, Colorado.
I p~an to build on ~:y property in Indian River Estate9, St. Zucie County,
rort Pierce, Florida upon retirement or upon recievino ~~lita~ ordera
a loca~:ion -•.::ere ~r~y fa::ily can not accompany me.
' fIlEO AND RECORQEO
ST. LUCIE COUN7Y ilA.
~ CLER
~CI~CUITaCOYRT
; IlECORD YERIFIEO~
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f Ju~ 1 f0 3s AM'T I
~ ~10180 ~
} 1 FURTHER CERTIFY that 1 will comply with all other requiremenit of a le~sl resident of this State. ~
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~ 1 FURTHER CERTIFY that I have no intention to return to my former domiule, and 1 intend to remain in FORT
~ PiERCE, SAINT LUCIE COUNTY, fIORIDA, permanently. .
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~ J ACK R. iV~T:~CI:iS
~ (Name)
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# Ea s. V Cor~s, ~PO idew York 09079 _
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5erving xith US Arcred ~orces in ~.urope. (Address)
~ .,r'u ~iew York OyU79 _ ~
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~ Sworn to and suburibed before me this ~~St day of J~~ _ , 19?~ •
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~ ROGER ?OITRAS -
a' Ct~RK CfRCU1T COURT Notsry ublic
~ Suimur~ry~~ourt~a~rt~~LO~ ceT
~ By D.C. My ~ommission sxpires
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~ Re b~ ~x~cul~d in d~ icat~ •nd ori9inal Hl~d wMh CINIc Gra~it Cour1, and dupliuN with Tax AsNawr.)
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~ 19z 2808
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