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1 U TIiC STATE ANO CUUPfiY T/1X ASSCSSpR,
:1. lUC1E COUN1 Y, FLORIDA: '
This is my decla~ation of Uomicile and Citizenship in the State of Florida that 1 am fiiing ~his day in accordance arxl
in confo~mily with Chapter 222, Scction 222.17, Florida Statutes. .
1 was formerly a legal ~esidenr of _ D~arborn j~ic
(Cify) (Sfate)
and I ~esided at 1711 •North Mildred . However 1 have changed my domiGle
- ~ (Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since day of
Angust ,~9 7z, and 1 reside ~at 2023 St Lucie Blvd, Lot 197 ~
~ Whispering Creet~eet and Number)
FORT PIERGE, SAINT LUCtE GOUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actua! legal residence and domicile in the State of Florida.
(Insert here any pertinent facis.. such as sale of property or business, or relinquishment of employment
at former dorriicile, remova! of family to new domicile, purchase of home, etc.) ~ ~
2~64
Applying, for Homestead xx
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. RECORO VErIFlEO,,.,,`~
. ~ I~l~ut 11 ~p jo ~ .73 ~
, ~
.
1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that ! have ~o intention to return to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently, ~
,
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. ;
~ - ~ v~i ~ (Name)
` ~ ~~~~~G.' Edith M. Bilton
: ;2J o'. * .
~ ~ " ~
~ t ~ ` a~' ~ v = _ (Address) -
y' ~ t
.n\.'#.i.. • : !t• • ~ ~ ~
s 1.`~~
~'•~v4i(.c~?n. ~i a6cp~b~
ed, before me this 21 ~ t day of - March , 19_.Z~
'ti~ut.~~~~+•~`' ~ • • .
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ROC~R pplTRAS
~RK C(RCUIT COURT Notary Pubtic
~ '
~Y D.C. My Commission cxpires
(To be oxocuted ih duplicalo and ori~inal (ilod with Clerk Circuit CouM, and duplicalo with Yax Assesw~.) _ ~
d00K~1~ PACf
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