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219510 R....~F o.,~.
Eorm C-601-D-(300-3-12-56)
Declaration of Domicile and Citizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR. ~
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_ _ ST. LUCIE _ COUNTY~ FLORIDA : ;
This is m~• declaration of Domicile and Citizenship in the State of Florida that I am filing this day in
accordance, and in conformity with Chapter 20412 LaH•s of Florida, Acts of 1941.
I was formerly a legal resident of Syracuse New York
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100 Semloh Drive ~~~ty~ ~SC~c~~ ~
~ind I resided at - . However, 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 , ls~~ , and I reside at ~nlan Road, Lakewood Park, xoute 2~
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BOX 2764-73 ~Street and ~umberl
Fort Pierce St. Lucie County, Florida,
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(City)
and this statement is to be taken as my cieclaration of citizenship, actual legal residence and domicile in
the State of Florida.
tip.p anv oertinent facts, such as sale of property or business, or relinquishment of employment at
former domicile. remuval of famil3 to new domicile. purchase of home~ etc.)
My wiie 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. ~
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i~~EO ~M~ RECoRpE l
~ SL WCIE COU[ITY L
i ROCER FOlTR4~
CIERK CIRCUIt COURT
` IIECORD VERIFIED
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I FUftTHER CERTIFY that I will register at m~• local address when the registration books reopen,
= and comply with all other requirements of a legal resident of this State.
I FL'RTHER CERTIFY that I ha~e no intention to return to my former domicile, and I intend to remain ~
in Fort Pierce St. Lucie _ County, Florida,
_ ~cicy~ ~
permanentl~ . '
- G~---- - - - Lt....--~
( Name)
Route 2, Box 2764-73, Fort Pierce, Florida
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: . `~~~~~~~?~~i~~:.,,, (Address) 33450
~ 23rd
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; (To b! e~t~1l1ltiet~1in duplicate and oriKinal filed with Clerk Circuit Court) y
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