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DECLARATION OF DOMICILE AND CITIZENSHIP ~
TO THE CLERK OF THE CIRCUIT COURT, e~;~a~~~t3~ ~
ST LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State
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of Florida that I am filing this day in accordance, and in con-
formity with Section 222.17, Florida Statutes.
As of ~snuary :5, 2976 I established a domicile in ~ ;
the State~of Florida located at Link port, Fort pierce, F1or~da
- , where I reside and I have been a bona
fide resident of the State of Florida since ~anusry 15, 1976 ,
I maintain other places of abode outside of the State of i
Florida, to-wit: - .
Province Line Road, ~ ~ _
Ski2lman, New Jersey N $ ~rr ~
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however, my Florida domicile, set forth above, is my predominant-and
principal home and I intend to continue it permanently as such. "
; This statement is to be taken as my declaration of citizen-
; ship, actual legal residence and domicile in the State of Flori.da.
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I FURTHER CERTIFY that I will register at my local address when
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; the registration books reopen, and comply_with all other require-
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f inents of a legal resident of this State.
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ame ~ j
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Link Port - (
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~ • Fort.Pierce, Florida ~ ~
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~ SWORN to and subscribed before .fi...,.
z me this 16th day of January , 1976. -
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~ (To be executed in duplicate and original filed with Clerk of the
~ Circuit Court, and duplicate with Tax Assessor).
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~ THIS DOCUMENT PREPARF.D BY :
~ Thomas P. Ford QR ~Q
53 Wall Street frt~ ~~7 P~ ~
a.,,.,,, ~..Y. 10005
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