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Declaratioe~ Qt ~omicile and ~itizenship ~
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TO THE STATE AND COUNTY TAX ASSESSOR, j
Sl. LUCIE COUNTY, FLORIDA: ~
This is my declaration of D~micile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
~
I was formerly a legal resident of H1T~tl . GeOr~la_ t
(City) (State) ^ ~
;
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i
Route 2 '
and I resided at - . - - - . However I have changed my domiGile ;
(Street and Number) ~
~2 i
!o and am and have been a bona fide resident of the State of Fl~rida since day of ~
i
January _ ~q_66, and I reside ar _ Z?.02 ~lo*'ida Avenue '
- _ _ - - {
(Street and Number)
FORT RIERCE, SAINT ~UC1~ COUNTY, FLORIDA
and this statement is to be taken as my declaration 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 of family to new domicile, purchase of home, etc.)
~
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F
~ntering Ila Mae Asl~ in 6th Garde ~
" Wm Brunell Ash, Jr. in 3rd ('rade ~ o", z„n r
rn ~
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I FURTHER CERTIFY that I will comply v~ith al! other requirements of a legal resident of this State.
a
f 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, FLORIDA, permanently. ~
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- -~1C,~ ~.d ~ I
; " • ~ - - (Name)
i " . '
, . .
E ° • Louise hiae ~x Ash
i - • -
• . ~
` - (Address)
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.
-~~•=,t t~S'y~,w"tn `fo ~nd subscribed before me this 20 _ day of _ Jariu1T}t , 19 66
.R_~ir .
ROGER POITRAS
C ERK CIRCU COURT Notary Public
g _ ~ _ D.C_ My Commission expires
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; (To be executed in duplicate and origina) Eiled with Clerk Circuit Court, and dupiicate with Tax Assessor.)
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