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Dectaration of Domicile and Citizenship '
~ ~o~
TO TH~ STATE ANU COUNTY TAX ASSESSOR, ~
_ S t. Lu c i e COUNTY, FLORIDA: !
This is my decla~ation of Domicile and Citizenship in the State of Florida that 1 am ftling this day in
~ccorJance, and in conformity with Section 222.17, Florida Statutes.
1 was formerly a legal resident of Z i o n , I 111 n o i s and 1
~sc:a~
rensided at 210 0 E d i n a B 1 v d. , However, t have changed my domicile to
(Street and Numbet) 1
and am and have been a bona fide resident of the State of Florida since day oi ,
April - 20? Beach A~enue
, 19~~.., and 1 reside at ,
(suK~,~a H~e~)
Fort Pierce , St. Lucie County, Florida,
(~h)
and this statement is to be taken as my declaration of citiz~nship, actuat lega! residence and domicite in the State
' of Florida.
(lnsert Aere any pertinent facts, such as sale ot property or businest, or reliaquishmeat ot emplormeat st to~er
domicile. removal of familr to ~ew domicvs, purchase ot home, etc.)
I retired from The Peoplea Gas Zight ~ Coke Co., Chicago,
and have purchased a ho~e here.
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i I FURTHER CERTIFY that 1 will register at my local address when the r~egistration books reopen, and
€ comply with all other requirements of a legal resident of this State_
I
[ I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ - .
~ ce i, St_ I.ueie , County,
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i :iy ~
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f . ; Harry Luther~''~~
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: ~.;~~:.Lv~~~.i`~~:n (
~ SwAs~i~,'Eo+arttl subscribed before me this 2~_ day of .
~
` April :
: . A. D. 19~. . i
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Notuy Pubpc State of Flori at LarEe
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e My Commission expires__~Z -!6 ` 7 3 ~
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~ (To be executed in ~uplicate and wqtinsl filed with Cletk C'vcuil Coutt, aad duplicate wi16 Tu Assaao~) .
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