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ST. lllC~
Declaration of Dom ~vn~' Citizen~iQ
TO TH$ STAT$ AND COUNTY TAZ A88)eS8OB.
sz. LIIaia oovrn~r. rzo~ros:
This is a-7 declaration ::2 Dotnidle and t~tisesship is tbs State o! Fbrida that I am ~ this ~,Y ~
saordanoe, and in conformity with Chapter 222, Section 222.17. Florida Statntea.
I was iormer~Y a legal resWent of _-~`LTQH -- --- ~~ ._--'_'
rcxs~i
~~~~_~/ .1 ! .. .i\.~ ' _ - YTf`fY,~V~Tj ~ n~VA COiR~ ~ ~le
and 1 resided at----------- -- -- - _~-_-------------- - - - -
(8ts+st asd Ntmtbz) 81st
+~ erg .,., and have been a bona lids resident of the state of Fgorida sinoe--------------------------------------d~Y ~
Sept . , 60 a~ I reside a~_?~.~ Low ~ 8t .-Bir~L~Y.~_---------------
------------, -9_- - - - - -
>~~ : Pia ra a St . Lno is ----~-~'• Florida,
_.
and this statement is to b~ taken sa my declaration of citis~iahip. actual ~ residence snd domicile in
the State of Florida.
(Lwst bars atV p~rtinfat taesa. twelt as tta4 d _yroDuCY ar ~ ~ °=i~e~n~t o~ ~pbym~st ~
torma do~kil~. r~ato~d ~ tamit7 to new domiew. ~
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n...71TT ~..r.,....•v .~... T rill rngi~trr wt my IOCal atidretta when the rgsstratitTn hooka reopen,
i F'tJninrt. va....._ . ~-• •
and comply with all other requu~emenLa of a te~i ~itiiw7t of ` °ta!t•
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain
in_ 1~y_-P~~~----------------------------------------~ ----~~---~~_-------------------~ntY. Florida,
(Cit=)
permanently. --~-5~~-~ /~~`~4_-___-----------------
-- - (Nt~)
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(cwt aed 1rn~e~)
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913UU
I:IL~ , AN~~D//~~ RECO~OED _
•/i/ wAAV
IN rsuun
1961 JAN 12 PM 12: 04
~i. LUCIE COUNTY, FIORIOAI~'"
S
Saof~t•4q'~1 >iufiscribed before me this----~I}_..c:sy of
• ',•~{p(;ag.~~l~-CL~RH CIRCIIZT j{OIIIti`
.~ --
•,, 4
Dsp.Ol~rk
(To b..z.eot~a ie enDlieab .ud e:fslaal _ ~lt1i U.dc l~raak e~aet..sd doelkste with Tas Awss~)
Ro~+w af.vlr C... Pt.ft CIt1. Tlf.