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Oeclaration ot Domicile and Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR, 22Q89~ ~
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Sl. LUCIE COUNTY, fLORIDA:
This is my declaration of Oomicile and CitiZenship in the State of Florida that I am filing this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes. i
Weet Chester penn
I was formerly a legal resident of
(C;ty) (State)
and I resided at _ Rt D- 1--_ However 1 have changed my domitile
(Street and Number)
to and am and have been a bona fide resid~nt of the State of Florida since 16th day of
__~43_C-~mb@r---- - . 19 and I ~eside at --~i~~ Tprnr~i iwn
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal r~sidence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of family to new domicile, purchaae of'rttame, etc.) ~
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Eatabliahing residence and wilLapply for homeatead
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~~D ,1 Mr? RE
- R ~p~r"~IR~~
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Rt E~ ~~I/Rt
, 11 I `~~K
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~ 2~89~
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Y.
~ I`FURTHER ~ERTIFY that I will comply with all other requirements of a leyal resident of thia State.
~ _i ~(JR~I.{~ CERTIFY that i have no intention to retum to my former domicjle, and 1 intend to remain in FORT
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~ PIERCE~ SAINT ~GI~~GOUNTY, FLORIDA, permanently_
~ 1~ : ~~~/:1
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5~ ~ " j.~~,c;..
_ ~ : John hbe
_ t_ . - g ger
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= Swom to and subscribed before me this day of -~~e~Q w , 19-~1
:3
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
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By ~OL~`~'~ D.C. My Commission expires
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(To b~ ~x~cut~d in dupliuts and oripinsl Rl~d with Cl~fc Gnuit Courf, and dupliut~ with Tax Ass~asor.)
h~ 600K1i78 PACE UY~
No. 13 q •