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Declara~ion of Domicife and Gitizanship ~ i
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T~ TNE STATE AND COUNTY TAX ASSESSOR, ~~~JE)~ ~
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Sl. LUCIE COUNIY, FLORIDA: {
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This ~s my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
ir, conformity with Cliapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ______~~9aZ~E~f4~[?~- prlllCe-tOll j
~C~ty~ (State) !
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and I resided at However I have changed my domiCile
(Street and Number)
20th da of
to and am and have been a bona fide resident of the State of Florida since y
_ . December_ ~q_54_., and I reside ar ___3I06 _Mura__Drive _
(Streei and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLO'RIDA
_a L_ _1. .J...-1> ..t el,~., n~t~~~l Inna~ ra~irlnn~ca a~~ rlnmicile in the State of Florida.
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(Insert here any pe~ tinent facts, such as sale of prope~ty or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.)
Applying for homestead ~ ~
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. I~I ~._Q_y RECORDED
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. - - . - ~ ~ = '~6 FEB y AM 10 : 53
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' ~ ROGER PO! i R~~S. CLERK -
~ ~ ST. LUCIE COUNTY.
~ ~ FLORIDA
~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
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' ~ FURTHER, CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT
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f PIERC~;, SAINT~ t'l#CI~,COUNTY, FLORIDA, permanently.
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~ , ~ . ~ . ~ - . ~ ~ (Name ~
~ . : David Dingman
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Sworn to and subscribed before me this 4th day of -~'eb , 19-5.h.
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ROGEFt POITRAS
RK CIRCUIT COURT Notary Pubtic
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B "~'Q-~'~ - D.C. My Commission expires
(To bs executed in duplicate and original filed with Clerk Circuit Court, and dupliate with Tsx Assessor.)
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