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DeClaration ot Domicile a~d Citisenship 22~6,~0
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. LUCIE COUNTY, fIORIDA: ~
This is my detlaration of Domicil~ and Citixensh~p 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 was formerly a legal resident of _ CHICAGO II,I,INOIS
- (City) (State)
and t resided at _ 3835 West _E~T th P1rlC@ Howeve~ I have changed my domitile
(Street and Number)
ro and am a~d have been a bona fide resident of the State of Florida since 3rd _ _ day of
Jul~f _ 19_71 , and I reside at ___2010 SO.__11th Street
- - _ . (Street and Number) -
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this stateme~t is to be take~ as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Filing for Homeatead Eze~ption
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WCIF COUyT~
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E AN 11
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~ 1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal residant of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domiGle, and ( intend to remain in FORT
~ PiERCE, SAINT IUCIE COUNTY, FIORIDA, permanenNy.
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~ _
~ .
~ .
~ ~ - (Name) ~
~ ~ • Robert R. ~'rarilcl~n ~
: ~ - i
= 2010 SO . 11 th Str _pt
i
(Address)
~ -
Sworn to and subscribed before me this ?th _ day of January ~ ~q 72.
_ ~ ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
.y
By ~ D.C. My Commission expi~es
~
_ (To be exscuted in dupliute and ori~inal filsd with G~rk Grcuit Cour1, and dupliuts with Tax Ass~s~or.)
~ b00K 1~70 PACE17~
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