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Decl~_ration ot Domicile and Citizenship
235826
- TU THE STATE AND COUNTY TAX ASS[SSOR,
Si. IUCIE COUNTY, fIORIDA:
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This is my dedarat~on o( Uo~nicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
~n conformity with Chapter 222, Section 222.17, Florida Statutes. t
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t was formerly a ~egal resident of . ~~"LL 7 L J j~~~
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and I resided at ___~`_'J!____r . . However 1 have changed my domic,ile ~
(Street and Number) '
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to and am and have been a bona fide residem of the State of Florida since _l~ ~ - C - Y f
_ , 192 .Land I reside ~at _ ~w`' ~
(Street and Number) ,
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FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA = , ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Ftorida. f
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(Insert here any pertinent facts, such as sale of property or b~siness, or relinquishment of employment ;
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying, for Homestead
Entering children in school :
To Establiah Legal Residence St. Lucie CountT, Florida ,
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CIERK 4+:~'~tT COUpT ~l~ ~
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1 FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ THOIIIAS ~T. ED~YARDS
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(Name ~ ~
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~ SviW~r~~ ~sG~ibed before me this ~ U~ day of , 19~
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~ .~%~~QL~RI(-4~ l{1 COURT Notary Public
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By _ ~ _ D.C. My Commission expires
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~ (To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assesso~.) ~
800~ 205 PA~~ 2435 ~
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