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St. lUC1E COUNTY, flR.
Declaration of Doniiciie and Citizenship -
TO THS STATE AND COUNTY TAY ~ /1Ei8s880x.
Thi. ~ mY decLration c! Damidls and C[tlseoshi~ in the State of P'iorida that I ana dlin~ Chia day in'
aaordance, and in ooniormity with Chapter 288, 8estion 2ffi.17, Florida. Statutes,
I was iccmerly a legal resident of Lw~t - "'' ----~ ~~) - .
(CW)
and I resided st_.____ ROtite _S _____--~_-.._._.. However, I haw changed my domkik
(&reot aad N~L~rI
to and aaa aad have been a bona sde resident a~ the State of 1+7orida since-____-- ° ---------•------------_u~:yvi'
- - ~~-- _______.--------, ,0,60--, ..,,~ T > ~c--- 504 1[~Q way: ~it• Citt _.
- (8tawt a»d 1~Iambes)
_ F D~t i Z~~ e] --, _~T Oy ~ aNNi s~ -..-_W%NWiw, T~ivi ~YN,
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and this statement is to be taken as my dedsration o! dt3senahip, actual legal residenos and domicile in
the State o! Florida.
((Lwsc Dare aw- p.stiep-t tads. soe~ as .a1. o~ ~roparti or d ~ ~:~~~°t of eo.~los~as st
fo:sar doakM. ramo~a] at iaedb to naw s. Daree~sse
- FlCL~D~~CDRDED
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1961 JAN I D A' 11:59
ROGkK POITRA:.=, ~,.~~"
• ST. LUCIE COUNTY, FIGr,,. A
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and comply with all Other reQuir~ti o! a lagal iresident amt this State. ~ ~ tiOD bOOka !'eoQen,
::.. i :...a..r ~ :~.:.,.
I FURTHER fii IF3C that I bsre no mtiel~ ~ ran ~ ,w~ .+~a~ :::. -~'-` ~"
~ ?ort Piore• ~ 8t. Lmoio ~ g~a,
~'r.ai satr.ns.
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'•. .fj~ tii. ~a+Aei fa drpllasto• er0 eal~si ~! wlM~ ~ f>aek Q~s1, esi ies~eeAe wiW 'lys Ae~eeeee)
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Mr M!'~i'" ~. lMot CMS. Tls. ... -