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qect~ratic~n ot Domiciic~ and Gitizenship -
TO THE STATE AND COUNTY TAX ASSESSOR,
_~.~~~~t ~}`t
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filinq this day in accordance and
in conformity ~vith Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of PQrtSml~h__-_ _ _-___Va~_.
(City) (State) s
r
t
3609 Turnpike Road ;
and I ~esided at _ . However I have changed my domiGile ;
(Street and Number) ;
~
to and am and have been a bona fide resident of the State of Florida sinc~ _J-5___. _ day of
i
816 ~rancis Lane
SepfiembC'I' ~q__ _65and I reside at '
(Street and Nu~ber) ^
FORT PIEitCE, SAINT LUCIE COUNTY, FLORIDA
and th:~ statement is to ~e taken as my declaration of citizenship, actual legat 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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. Applying for homestead
: ; 'NtLE AND+RECORD~D
: ~ _ ~ ~ ~ . . - -~t~'*~+ 9 ~ n k
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66 JAPr 2 I pM S p =
~ _ . ~ 1-~2ti~1~~ ~
` : ~ ~ ROGEFt P~ITPAS. CLERK ~ s
~ ~ ~ ~ ST. LUCIE COUNTY. {
FLORIDA
1 FURTHER CERTIFY that I will comply ~vith all other requirements of a(egal resident of this State.
z.
k I,FURTHER CERTIFY that I have no intention to return to my forme~ domi~ile, and I intend to remain in FORT
; . .
; PIERCE; -S'AINT .LU~J~j CAUNTY, FLORIDA, permanently. ~ ;
. - . / :
• ~ ~ . . L' ~ - ` / I
~s /••ly+ / -_-~i'w•?• t
' ~ ~ ~''1• \ ~ - / -
J . -
~ - . ; . (Name) i
~ - • , Steven Smith ;
i ~ , - ~ ~
~ . (Address) ~
3 - ~
~
Sworn to and subscribed before me this 21 day of - ~anaury ~ 19 66
i
ROGER POITRAS
~ LERK CIRCUIT COURT Notary Public
gy D.C. My Commission expires
(To be executed in duplicate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
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