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Declarat~on ot Domicile and Citizenship
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TO THE STRTE AND COUNTY TAX ASSESSOR, '
~l. LUCIE COUNTY, FLORIDA~
This ~s my declaration of Dom~ule and Citizenship in the State of Florida that 1 am filing this day in accordance and
~n conformity with Chapte? 222, Section 222.17, Florida Statutes. .
I was formerly a legal resident of
4lfilkea-Aarre-_ _ -
(Ciy) (State)
and 1 resided at R. D. 5 Shavertown How~ver I have changed my domi~ile
. (Street and Number)
!o and am and have been a bona fide resident of the State of Florida since Oct . 1 _ _ day of
, 14_7.1 , and 1 reside at 42F Oleattder Blvd.
_ _ -
(Street and Number)
FORT PIERCE, SAINT tUC1E COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual fegaf rpsidence and domicite in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, rs:^~va: ~a~~~„y to new domicile, purchase of home, etc.)
Establishing residency and filing for homestead exemption
F~LEO tN~ RECGRDEP
ST.LUCIE COUMTY FLA.
aOCE~ Po1TR?S ~
CIERK C~RCUIT COWtT
RECORD YEF.~FIEO~~.....~.1
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F
S
219129
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I FURTHER CERTIFY that I will comply with all other requirements of a(egal r~sident of this State.
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I FURTHER CEic i i"rY that i have no intention to return to my former domiCile, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ,
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! ~Name) ~ ' . ,
I~arry`~.; (;oeringer . _
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- (Address)
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Sworn to ind wburibed before me this J9 _ day of ____~<_-1~~~~ _ , 19-L__.
_ -
~ ROGER POfl'RAf; - - -
CLERK CIRC~rCOURT Notary Public
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- By - ~ . , ~-1C-~ D.C. My Commission expires _
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(To be executed in duplicate and original ~iled with Cle?k Grcuit Court, snd duplicat~ with Tax Assessor.)
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