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i")e~*Is?ra~i~n nf ~t~t~jcile Attd C~t1Z~t18h1~I -1-~~~~~[~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA:
Tr~is is my declaration of DoRiicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conf~rmity with Chapter 222, Section 222.17, Florida Siatutes.
I ~vas formerly a legal resident of SOUt~l _~I11~4~?__ _ ____I1j~~y J~~~~------ ~
(City) (~iaie~ ~
:
5 J u pi t e r ~OL1I t Ho~vever I have chan ed m domi~ile
and I resided at - - - _ . 9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ____.8th day of
November 65 167_ Solaz iave ~
- , 19----, and I reside at - -
(5treefi and Numberj
Ft)RY PIERCf, 5AINi' LUCIE COUNiY, PL~RiDE1
and this statement is to be taken as my declaration of citizenship, actual ~egal residence and domicile in the State of Florida.
(Insert here a~y pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to ne~v domicile, purchase of home, etc.) jp
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Applying for hamestead
: ; FILFp qfVD RECORDED
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~ ~ I FURTHER CERTIFY that t wiil comply with all other requirements of a(egal resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
€ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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' _ ~ • . Mrs. Mary K Carew me)
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_ (Address)
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' Sworn to~and subscribed before me this 14th _ day of - , 19 6~?
.
ROGER POITRAS
,~ERK CIRCUIT GOURT Notary Public
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g D.C. My Commission expires
i y.
(To be executed in duplicate and original filed with Clerk Circuit Court, and dupliwte with Tax ~lssessor.)
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