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DeClarat~on oi Domicile and Ci~i=ens~~tp ~
TO THE STATE AND COUNTY TAX ASSESSOR, ,
Sl. IUCIE COUNTY, FLORIDA: ~4Q~166 ~
This is my dectaralion of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in con(ormity with Chapter 222, Scction 222.17, Florida Statutes. - tx`
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1 was f~rmeriy a legal res~dent of _ Gettysburgh ~ Penn. .
(City) (State) ~
t
and I ~esided at _ R. D. #9 However 1 have changed my domiGle
(St~eet and Number) ~
to and am and have been a bona fide resident of the State of Florida since OCt. 17, 1972- day of
- , 19^-, and I reside 'at ' BoX 72 - R. D. 1
~ (Sireet and Number)
' Fort Pierce, Fla. 33450
FORT PIERCE, SAINT tUC1E COt1NTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. r
(Insert here any pertinent facts, such as sale of property or business, or ~e(inquisF~ment of employment
at forme~ domicile, removal of famiiy to new domicile, purchase of home, etc.)
;
Applying, for Homestead ~
- Entering children in school : X ? p,1MD R ~
~o~~~Y g~~. s
Roxanne $~X~X Decker O~~RK C
gCUtT ~p~RT
~ . aECOao vea~~iEO ~
Oc~ 10 ~M'1~
- ' 24U066
~
1 FURTHER CERTIFY that I will comply with all othe~ requirements of a legal ~esident of this State.
i
1 FURTHER CERTIFY that 1 have no intention to return to my former domiule, and I intend to remain in FORT
, PIERCE, SAINT LUCIE COUNTY, ftORIDA, permane~tly. ~
a
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I
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(Name) ~
Clyde L. Decker ~
~
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(Address) . ;
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4 Sworn~ i'o, a6c1~ ~~bscribed before me this day of - ~C.T ~ q,,,~L~
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' _ '~~v~' `+•r~.~•.'i• ' ~ I
~ ~ R~a~~di~~~i~ I:
..:w~ , 7
f - N CLF~„RI~jCIRCUI~"E~1 Notary Public
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.ti.:... ~ r : .r?; ~
~Y ; . . ~ D.C. My Commission expires ;
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(To be oxecufed in duplicate and oriqinal filed with Clerk Circuit Cour1, and dupliwte wilh Tax Assessor.) ~
1 PI1CE~~ ~