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De~l~ra4ior~ ot d~rv~icil~ anci ~itiz~nst~ip
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TO THE STATE AfJD COUNTY TAX ASSESSOR, i~I,~y1
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Sl. tUCIE COUNTY, FLORIDA:
This i; my ~eclaration of Domicile and Citizenship in the State ~f Florida that I am fiiing this day in accordance and
in conformity wilh Chapter 222, Section 222.17, Florida Statules.
I was formerly a legal resident of ShelV~_ VlZ1~ _ KeI~tUCky
(City) (State)
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Rural routE Nowever 1 have changed my d~mi~ile '
and I resided at _ - - - - .
~~iia.~.i 6iiiJ tiiiiiiiEi~i j
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to and am and have been a bona fide resident of the State of Florida since 2$th _ day of
old ~ensen Beach Star Route
DeCembe~ 19_ ~_5, and I reside at ._U--S_#--1----(19 mili s s~~i _h a~ Gity_----
(Sireet and Number)
FOR'f PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicite in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc.)
Hstablisliin~ residence
FIIED aND RECOROED ~
` . . IN._ ' 300K '
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'66 JAN 3 I AM 9. 52 i
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. +':j '~j ROGER ~~~j ~ ~~+S. CLERK •
- - ST. LUCIE COUNTY,
~ . FLORIDA
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I FURTHER CERTIFY that I will comply with all other requirements of a iegai resident of this State. ;
1 Fk1R7HER CERTIFY That I have no intention to return to my former domicile, an~' I intend to remain in FORT ~
' t~~ii;~;r~r.,
PIERCk>`$iAiNT Llj~.'(Bif~OUNTY, FtORI~A, perrr.anentiy.
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: t; : W . - . (Name)
• = , ~ . ; - Rogex L. Yount
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' E. L. Yount
3x Janaury 66
Sworn to and subscribed before me this _
da of ` _ ~q .
Y .
ROGER POlTRAS ~
RK GRCUiT C~DURT _ ~ Notary Public
By ~L`"~~ D.C. ~ My Commission expires ~
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(To be executed in duplicate and original {jl~jd , (erk Cir '~t,~ourt, and dupliute with Tax Assessor.) . f
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