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D~a~l~ration oi Domi~it~ and Citiz~c~ship
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TO THE STAT~ AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, fLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conforinity with Chapter 222, Section 222.17, Florida Statutes.
CiQero New York NeW York
1 was formerly a (~gal resident of _ t.--------------- -
(City) (State) ~
an~ I resided at R•F•D! _ _ _ . Nowever 1 have changed my domiGile ~
(Street and Number) ~
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to and am and have been a bona fide resident af the State of Florida since .~_l~t day af
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------`T-~ - 19 b5- and I reside at _160~ Z6ph~' AVA. t
(Street and Number)
FORT PIERCE, SAINT LUCIE GOUNTY, FLORIDA
and this stateme~t is to be taken as my cieclaration of citizenship, actual legal residence and domicile in the State of Florida. ~
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment #
at former domicile, removal af family to new domicile, purchase of home, etc.) j
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~CPi ESTF.AD
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. ANp RE~ R~~~d '
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I FUR7HER CERTIFY that I wil! comply with all other requirements of a legal resident of this State.
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f FURTHER CERTIFY that I have no intentian to return to m former domi~ile and I intend to remain in F RT ~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. t
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(Na e~lf~ad Hi~ks ~
16U8 Zephyr Ave•, Ft. Pierce, Fla. ~
(Address)
Sworn to and subscribed before me this day of - ~~n~x'Y , 1966 .
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~ ROGER POItRAS
RK CIRCU{T URT ~ s, Notary Pubtic
By - ' ~•,C' ~~~i~\: J.~ u: ~My Commission ex ires
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(To bs axecuted in dup(icate and origin(~;~~t~d `i~~ ~~'erk Gircuit Court, and duplicate with 'fax Asseswr.)
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