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TO TNE STATE ANQ Ct7UNYY TAX ASSESSOR,
Sl. CUCIE COUNTY, FLORiDA:
This is my declaration of Domicile ar.d Citizenship in the 51ate of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florid~~ Statutes.
~ ~~,m~-~.. ~ ~o-„~ ,o~,~, Milford Ohio
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(City) (State)
and I resided at _$Q1C $5 . . However I have thanged my domiGile
(Street and Number)
s
to and am and have bEen a bona fide resident of the State of Florida since _ NOVembei' ~
- day of
- 19~'_5 a~~ i ;eside at ~Q~_~4t1~r11_~~~r~i_
(Street and Number)
FOR? PIERCE, SAINT LUCIE COUNTY, FLORlDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Ftorida.
(Insert here any pertinent facts, such as sale of properiy or business, or relinquishment of employment
at former domicile, removal of family to new domicite, purchase of home, etc.)
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Establishing residence ~ ~
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_ . _ ST. LUCI.~~~•,~~' Gt~~~~K I
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I FURTHER CERTIFY that I will comply with a(i other requirements of a legal resident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORtDA, permanently.
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:'~'~r~;; ti+i'1.lliam A~Na~~uer
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~ . Sy~orn to`,and subscribed before me this 12~ day of _ J~ua1"y ~ 9 66
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itClGER POITRAS
C K CIRCUIT COIJRT Notary Public
BY 0.C. My Commission expires
(To be executed in dupiicate and origina) filed with CI a~Cj~c~j~COUrt, a i~~liwte with Tax Assassor.)
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