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Form C-601-D-(300--3-12-b6) . 1 P.,,T~, v~~~.
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Declaration of Domicile and Citizenship
TO THF STATE AND COUNTY TAX ASSESSOR.
_ ST. LUCIE COUNTY. FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in ;
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accordance, and in conformity with Chapter 20412 Law•s of Florida, Acts of 1941.
I was formerly a legal resident of S Yracuse New York
(City) . ~ (State)
and I resided at 100 Semloh DY'ive . Howe~er. I have changed my domicile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since lst day of
November , 19~~ . and I reside at ~nlan Road, Lakewood Fark, Route 2,
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$OX 2764-73 (Street and Number)
Fort Pierce St. Lucie County, Florida,
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( city>
and thic statement is to be taken as my declaration of citizenship. actual legal residence and domicile in
the State of Florida.
(Insert here anp pertinent facts. such as sale of property or business, or relinquishment of employment at
former domicile, removal of famil}• to new domicile, purrhase of home, etc.)
My husband and I purchased a lot in Lakewood Park, St. Lucie
County, Florida, and had a home built thereon and moved into
said house on November lst , 1970, and have resided there
since that date.
FI~ED /?ND REC 0
~ t?.liiC{E COUfIT~ `
~ ROCEit POITIU=
~ CIERI( CtRCWT ~OIMT ~
; RECOIro vERIF1E0~.,,~..~
` No~ 26 2 os'N't 1
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` 21.9509
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I FL'ftTHEB CERTIFY that I will register at my local address when the registration books reopen,
and comply with all other requirements of a legal resident of this State.
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I FL'RTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
~x in Fort Pierce , St, Lucie
County, Florida,
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= (City?
permanenth~. `
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_ (Name)
Route 2, Box 2?64-73, Fort Pierce, Florida
. - - - - - - - 33-~50
_ ~ir. i r~,~~ ( Address)
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Sworn to and su ~toefo~~hia' ?~rd day of
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4 ~ cS A. D. 19_ 71 . ~fp
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1 , Commissiop~~ - 7 -
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~(~11«~i1tilX~evted in duplicate and original filed with Clerk Circuit Court) ~
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