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~eci~r~tion of D~micile a~d Citi~~n~h~p
TU TNE STATE AND COUNTY TAX ASSESSOR, -L`~_1aJ(jJ
Sl. LUCIE 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 conformity with Chapter 222, Section 222.17, F~orida Siatutes.
Vero Beach Florida
I was formerly a legal resident of _ _ _ . - -
_ _ -
(City) (State)
300 14th StreCt Hewever ! havechan ed m domiCile
and I ~esided at 9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ 17_~$__. day of
. ~
l~ecember 65_ 5101 So Ind.Kiver Drive
- 19-- , and I reside at
(Street~and Number)
FORT PIERCE, SA,INT lllClE COUNTY, FLORIDA
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and this statement is to be taken as my declatation of citizenship, actua't legai residence and ciomiciie in ine ~ia4e ~i ~i~iiua. ~
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying for homestead
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State. ~
I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I iniend to remain in FORT
PIEA.CE: SAINT LUCIE COUNTY, FLORIDA, perrr~anent{y.
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. SName)
~~i.-~~ a4 G. E. hoemaker
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' . . ~ - • t (Address)
' • -
. , .
~ ~ ~ 13th Janaury 66
Sworn to and subscribed before me this day of - , 19 •
ROGER POITRA5
RK GIRCUIT COURT Notary Public
gy a'`''~'~" D.C. My Commission expires
(To be executed in cfuplicate and origina) filed with ~lerk Circuit Court, and dupliute with Tax Assessor.)
BocK 13~ ~.34 -