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Declaration ot Domicite and Citizenship
• TO THE STATE AND COUNTY TAX ASSESSOR, ' ~~c
V
Sl. IUCIE COUNTY, FLORI~A:
Th~s is my deua~ation of Dom~ti~e and Citizenthip in the Stat~ of Florida that 1 am filin~ thit day in ~ocordanc~ ~nd
~n confo~m~ry w~~h Chspter 222. Sectio~ 222.17. Florida Ststut~.
1 we: formerly a tefl~l resident of l[iddle~own ~N. J.
(City) (Stat~)
and 1 res~ded at 11 Dakota Avenne 1~~• my
(Street and Number)
to and am a~d have b~en a bona fide resident of the State of Florida sinoe 20 - d~y of
, 19~ , and i rosid~ at u~ r_e~ c..~;.~g nr;op
(Sirset and Number)
Port St. Lncie - Ft Pierce, F1a.
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and th;: statement is to be taken as my declaration of citizanship, actual lefla! residenoe and domitile i~ the State of Hotida.
(Insen here any peninent facts, such as sale of prcperty or busin~ss, or ~elinquishm~nt of «nploym~nt
at forrrwr damicile, nrnoval of family to n~w cbmicil~, pu~d»s~ of hon?~, ~ -
Establishing neidency ior hasestead ezemption
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fIIED ~MO REGOIIOt~ ~
St.lUC1E COON?Y F~~ ~
C~EaK C{aCUi~~~~t ~`c~
. !tf CORD YERtfIE~
. DEC 10 9 52 aM'11
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~ 1 FUR7HER GER7IFY that I will o~mply with all other requiremenri of a(ayal resident of thi: Stets.
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~ I FURTHER CERTIFY that I have no intention to return to my former domivle, and 1 intend to remain in FORY
: PIERCE, SAINT IUCtE COUNTY, FLORI~A, permana~t{y.
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~ i (Name) ~
~ . Jacob Oberle
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~ (Address) ' ~
10 December , 71
Sworn to u~d subsuibed before me thi: day of 19
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_ RooE~ ~crraAS
~ :CLERI~ ClRCU(~ CgURT Notary Public
ey " D.C. My Gommission expires
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_ (TO ~N ~XKY1~ ie dupliat~ and ari~ina! filod with G~rk Grwit CouA, and p~icat~ witb Yax Ass~swr.)
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