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C~~~cl~r~ti~t~ 04 domicile ~nt~ C~tizenship °
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TO THE STATE AND COUNTY TAX ASSESSOR, i~`~~~~~~
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Sl. LUCIE COUNTY, FLORIDA: ~
This is my declaration of Domicile anci Citizenship in the Siate of Flarida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
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Ham ton ~nia--- - ~
I was formerly a legal resident of _ - - _ p-. - - - ~ ~
{City) (State) r
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and I resided at _ 36 Beach Road However I have changetl my domiCile
' (Street and Number)
to and am and have been a bona fide resident of the State of Florida since lOth__ _ day of
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Janaury 66 3110 B ~
- - - - - - , 19--- - , and I reside at - ---~5 t4T! Av~ . _
(Street and Nurr~ber) .
FORT PIERCE, SAINT LUCIE COUNTY, fLORIDA ~
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the :tate of Florida. j
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' (Insert here any pertinent facts, such as sa~e of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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Llementine '
Enterin~ ~uis~ T amb in school
6
Pam in Jr High scbool ~
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.r:?;,; ~
~ -~~%C:~~„'~~ FIL, AND RECORpED ;
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v ! U -l1#~~C~ ~ 0 0 ;
. ' ~ ' ~a , ~
- . - ~~E--'~
-f - ~ ~ ' 09 ~l
~ ~ ~ '66 JAN 2 0 A~ 9 • ~
. . . . '~~l.: _L~`~l~U ~
• `~1~\1 ROGER t~G~ ~ ~a~. CLERK ~
` ST. LUCIE COUNTY,
i ~ FLORIDA
I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State.
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I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend fo remain in FURT ~
• 3
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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, < < ~ ~~i ~ "~G,a-t~ l7l ~7f~ i
~ Li i~ - ~
' ~ (Name)
. ; ,,,.•1~+~.~ ~ =
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: n : Louise Lamb ~
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- = . . ``';:y j-,ti: : (Address)
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' `;•M1•..`..'~.~3;,
''~~Swo~ri'to and subscribed before me this _ 20th day of _ ,~an~ , 19~b
ROGER POITRAS ~
ERK CIRCUIT COURT Notary Public ~
gy D.C. My Commission expires i~~
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t (To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assassor.) f
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