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Declara~ion A~ [~omicile ~nd Citi~~n~t~ip ~
_~_~'~3UE~
TO TF~E STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUN7Y, FLORIDA:
This is my d~claration of Domiciie and Citizenshi~ in the Stat~ of Florida shat I am filing this day in accordance and
in conformity with Chapter 222, Section 222.17, 'rlorida Statutes.
1 was formerly a legal resident of . _ _ _ _ _ _ ~~1XIri0uI?t _ _ -_--_-1S~QSt--~1-Fg1T1~-&-
(City) (STate)
and I resided at _Rt S__ . However 1 have changed my domi~ile
{S'reet and Nun,ber)
to and am and have been a hona fide resident of the State of Florida since 21St_ day of
- December 65
- 19---- , and I reside at _24$ -SQ --2.~~1L__
(Street and Number)
FOitT PIERCE, SAIMT LUCIE COUNTY, FLORIDA
and this stater.~ent is to be taken as my declaration of citizens~~~p, acfival iegal residence and c3arnic+ie in it~e State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of emp!oyment
at former domicile, removal ~f fa?nily to ne~~v domicile, purchase of hame, etc.)
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I FURTHER CERTIFY that I 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 intend to remain in FORT
PIERCE, SAINT LUCIE COUN i Y, FLORIDA, permanently. '
: '~:t:t:.;;:;~; ~ :
_ ~ ; 1 i
. . (Name) ~
_ ~ Albert Spiker ~
- `i - . _ ~
` , . • ' ° ' (Ad ess `
; Cora Belle ~pi~er ( his wife) `
j •`,~;•~...r-j.•,` ~
~ ~ . ~
~ . Sworn~to~and subscribed before me this ~6th day of ----.~~rL~1~~}? , 19-_bb. ~
' ~
Rt'GER POITRAS ~
LERK CIRCUIT GOURT Notary Public ~
~~e~ts'~ ~
6y c-e- D.C. My Cemmission expires ~
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(To be executed in duplicate and originat filed with Clerlc Ci~cuit Court, and dupliwte with Tax Assessor.) ~
.
go~K ~.3~, ~.74 ~ ~ ~