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To the Stats and County Tax Assessor,
ST. LUCIECOUNTY, FLORIDA
This is my Declaration of ~omicile and Citizenship in tha State of Fiorida that 1 am filing this day in acoord-
ance, and in conformity with Settion 222.17, Florida Statutes, as amended by Chapter 26896, Laws of 1951.
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1 was formeriy a legal resident of___~~~ I_-
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and ! resided at
SnMf vmD~r Said City and St~q
However, 1 have changed my Domicile to and am and have been a bona fide resident of the State of Florida
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since day of 19~.5, and I reside at
-~~-------St._ IuCie Counry, Florida,
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. n ihis stateme is to be taken as my Declarotion of Citizenship, actual tegat residence and domicile in the
State of Florida. (Insen here any pe~tinent facts, such as sale of properry or business, or relinquishment of
employment at former domicile, removal of family to new domicile, purchase of home, etc.)
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I Further Certify that I will register at my local address when the registration books reopen, and comply
with all other requirements of a legal resident of this State.
j I Further Certify that I have no intention to return to my former domicile, and I intend to remain in
6 orida, permanently.
F u,r
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. Nam • usband ~
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Name • ~fe
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: weuc v~ErwNS - au waRs
Sworn to and subscribed before me this ____l_~__._____ day
Please Check
of - - 19~_.
• 1 - Spanish American ?
2 - Warld War I ?
Notary Pubiic or other Official t king Ack owledgment ~
3 - World War II
My Commission expires . 4- Korean Conflict ?
oeF[cuL sEAt. 5- None G
BARBARA L MOORING
NOiARr PUBIIC • CAUFOiiMA
OHANGE CAll1(T1~
Mr Caen Eip.~+ Moic~+ 28.1989
SoR~ 507 F~.,~E y69
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