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Dectaration ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR; 221383
51. lUC1E COUNTY, FLORIDA:
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This ~s my declaration of Dom~cile and Citizensh~p in the State of Florida that I am fil~ng this day in accordancc and
~n conformity with Chapter 222, Section 222.17, Florida Statutes ~
I was formerly a legal resident of Bri ^kt01rII_ _ __~@R J@r~~
(C;ty) (State)
and 1 resided at _ ?4 ~ 20th _ AVe However 1 have changed my domiGle ~
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(Street and Number) t
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ro and am and have been a bona fide resident of the State of Florida since ~ra day of ~
_.SS~tembe~ _ t9
7~_ , and 1 res~de at Rt. 1__ _ Box 124
(Street and Number)
FORT PIERCE, SA1NT LUGIE COUNTY, RORiOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as safe of property or business, or relinquishment of employment
at former domicile, removal of family to new dcmicile, purchase of home, etc.)
Hoae~tead Exemption
fIIED AND RECOROEO i
S1.lUCfE COUNTY F~A. ;
RO~ER POITitAS
i CLERK CtaCUIT C T
RECORD VERIf1E0
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~ I FURTHER CERTIFY ihat I will comply with all other requirements of a(egal resident of this State.
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~ 1 FURTHER CERTIFY that I have no intention to retum to my former domic,ile, and I inter~d to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, rmanentl
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Y ' • ~ ' • Ly A~
(Name)
~ ~ ' ~ Williem Dooling
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~ • Rt . 1 Ao~c 124 - - -
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Swom to and subscribed before me this 3rd day of Janua~___ , ~q 72_
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ROGER POITRAS -
t=~; CIERK CIRCUIT COURT Notary Pubtic
By D.C. My Commission expires
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r=~ (To be executed in duplicate snd ori~inal filed with Clerk ~:i~u' rt, and duplicats with Tax Assessor.) ~
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