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~eclaration ot Domicile a~ed Giti~enshl~, ~ ;
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TO YHE STATE AND COUNTY TAX ASSESSOR, - _ ;
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~ ST. IUCIE COUNTY, fIORIDA: • ~
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~ This is my dedaration of Oomicile and Citizenship in the State of Florida thet 1 em iiling thia day in accnrdante and ;
~ in canformity with Chapter 222; Section 222,17, Florida Statutes.
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~ I was formerly a legal resident of Lansin~ _ I11. ~
~ ~C~h ) (State)
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' ~ 3119 B l~~st Street
snd 1 rasided at ~ . Nowever I have changed my domir,lle
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~ to a~d am and have been a bone fide resident of the Stats of florida since 23rd day of ~
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~~i 6g - 341 Hernando S.E ~ ~
= JulY , 19_.._~, and 1 reside at (~treet and Number)
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~ FORT PIE~CE, SAIN? LUCIE COUNTY~ FLORIDA
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~ and this atatement ia to be taken as my deciaration of citizenship, actua! legal residence ond domicile in the Stata of Florida. `
(lnsert here any pertinent facts, such as sale of property or busineas, or relinquisfiment of employment ~
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~ at former domicils, remoral of family to new domicile, purchase of home, etc.) .
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Establishin~~residency and applying £or homestead ~
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~ fi ,ANp RECORQED . - :
. . ~~c~a! BOOK . , t.~ . . ~
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~ 1965 JfiN -4 AM 10: I 7 = j' ~;1~`~ 4 .
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' ~ ROGER POITRAS, CIERK ~ . = •
~ ST. LUCIE COUNTY, FIORIDA ,
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I FURTHER CERTIFY th~t i will oomply wit4~ ail oth~r res~uiremants of e le~ai ro:idan4 of thls State.
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} I FURTHER CERYIFY that I hava no inteniion to return to my former domi~ile, and I inte~d io r~main in FORT ~
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDQ?, permanently. ~ ~ t ~
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; ~ Bernard James Tobin
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; , Swcrn to and suburibed tsefore me this d*~+ slay of ~
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~ ROGER POITRA~
; RK ClRCUIT COURT Notary Public '
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~ ~ i gy D.C. My Commiss{on e~xpires :
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~ (To b~ ix~cut~d in du~licat~ and o~i~insl Al~d with q~ric GrcuN CouM, and duplicai~ wErh Ta~c Aa~pora
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