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Declar~ti~n o4 Domi~ile ~nd Cit{zenship ~ y '
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T4 YHE STATE AND COUNtY TAX ASSESSOR, i
ST. LUGIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship ln tha St~te of Fiorida thet ! am fiting thi~ day tn ac~.ordance and
in conform(ty with Chbpter 22Z, Section 222.17, Floridb Statutes. '
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. New York 3
R I was formerly a leya) ~esident af ~~'C~ ~
~ (City) (State)
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~ , However I~heve changQd my domtcJle ~
1 ~ and ~ ~e3ided at 124 Genesee Street _
(Street and Number) ~
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~ b and am and have been a bona fide ro:ident of the State of Florida sirKe 26 _ day of
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' December ,~9 6~, and I reside at b425 Riverlau~3 Drive
; (Street and Number)
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I~ORT lIERCE, SAiNT LUCI@ COUNTY, F1~~fIDA ~
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~ snd this statement is to be taken as my declarotion of citizenship, actual legal rasidence and domicile in ihe State of Florida.
- (Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
a et former dQmidle, removat of family to new dcamicile, purchase of home, etc.)
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' Bstab].ishing residence ~
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IN
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_ ~ . . . ~ 1964 DEC 30 AM 11: 30 . .
: ~ ~ ~ ROGE~ POt~R~ ~~~~R D~ ~ ~ ~ :
~ IE COUN
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~ ~ 1 FURTHER CERTiFY thnt 1 will comply with all oth~ar requirements of e la~el resident of this State. q~;: L
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; I FURTHER CERTIFY that I have no intantion to return to my forme~ domir~ta, and I Intcnd to remain in F~RT i
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. . ~
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E - - - . . (Name} (
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; ~ ~ ~ ~Bsther Hill Hop£iager ~
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.,Swom to, a'nd subscribed before rne thi: 34 day of December . 4
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F-~ ' L~ItK~ C tT CO RT Notary Fubik ~
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, gy ~.C. My Cemmiss(en expires ~
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~ (To be ~xreut:d in dupHe~h and ori~ie~! f~i~d with Cl~rle G~wh Casrt, and dvplieat~ wiNi Tax Ass~ora
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