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Declaration ot Domicite and Citizenship
TO i tiE STATE Af~iD COUhI Y TAX ASSESSOit. ,I
2'~'~2
Si. IUCiE COUNTY, FICRIDA .
Th~s ~s my deciarahon of Dom~aie and Crtizenship ~n the State of Florida that 1 am fil~ng this day in accordance and
:n conform~ty w~th Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legai res~dent of _-____Zongmeador~_ ^~dasa. _
(City) (State)
103 FairvieR ~treet
and I resided at _ _ - - ----T-_-_---------_ - Nowever ! have changed my domiule
(Street and Number)
November 24
so and am and have been a bona fide resident of the State of Florida since day of
Lot 175-~ - ~utd: or-F.eao~s
A-I-A South - Jenaen Beach, Fla.
- _ _ _ 19
71 and I reside at _
(Street and Number)
(prcperty in St. Lucie Co.}
FORT PIERCE, SAlNT LUCIE COUNTY, FLORIDA
and th~s starement is to be taken as my declaration of citizenship, actual legal residence and domiciie in the State of Florida.
(Inse~t here any pertinent 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.)
Establia'~ing reaidenc~
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ST.IUC~E ~OUNri FLA,
RGCE~ P~IT~AS
C~EitK :,~RCUIT CONRT
RECORp VER~FtED ~n
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1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
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I FURTkER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in FORT
~IERCE, SAIN7 LUGE COUNTY, FLOitIDA, permanently.
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V Name) p, Corydon White
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a. :~iwaf~`tp ~sY~d suburibed before me this 6th day of Beeember ~ 19 71
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= ~ ~I~U~T:COURT Notary Public
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- 3y~..' ~ . ~ = ~ ` O.C. My Commission expires
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- (To be executed in duplicate and original filed with Cler{c Grcuit Court, and duplicate with Tax Assessor.)
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afloK ~.97 PAGE2191
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