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• - _r. ~ BOOK - ~ 3 -135
Declorotion of ,Domicile and Citizenship sr. ~uclE' couNTr. FIA.
TO THE STATE AND COU]Ii~Y TA% A3SFJ3S0$
sT. Lvcla •oovrrrsr, FLOl~ems:
This is my decLration of Domicile -sad Cltlsenshlp in the State of Florida that I am Aling this day in
accordance, snd in conformity with Chapter 222, Section 222.17, Florida Statutes.
I waa formerly a legal resident of_T__-- _ ~.,t-~._-_--------
- ici~i ------ - __----, ___-- --tarns.)
and I resided at-- - ? 1$ _~1'_QP>~_ $~i-~.---:----------•---- --- ------- Ho~,rever I iuva ~m-te~2 my u+-;,::4iIE
(street sad Navber) _-... .
.. ., ...1 ~ 1'.ne+w w 1•anw.s was YYSS~dww• wt •1.I~ Q~.,•., ~ --7 ~' -
LV aTlfi Pun YVV llYt{i V~.~rM Y w.... ..vV .w.YVYY V~ WG VYYW Jl ~Ol •Yw OL~W---------- ---T~~~--___----_-_-.--VAS ./f
- ---JANIIART _ 1861_, and -I reside at_____109~0'.~_~sndiaa_~~es__-I2r~-- -
-" - - (Stre.t and Number) -(~e~~ofl
ll'T. PIERCE ..~ ST. LIICIE -
---------------------------------_____---- --------. • ---------- ---------------------------County, Florida,
(Cib)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida. --
(Insert here nay pertinent facts. loch a. sale 02 yroperty orbna ~; or~r;lingnLLmwt of emplo~m~at at
former domicile. removal -ot tamly to new domieUe. pnrehsre
?(fin
----..
l y , ~ ... . /~~~ ^ . ~ 1
r ~ ~ ; ~ R POITRAS, i~~ '-
S~. LUCIE COUNTY, FLT:; ,`y~jll
L•` - ~
- ~. - ~-
I FURTHER CERTIFY that I will register at my local address when the registration books reopen,
a::d ^..an:giy with all other requirements. of a legal zesident of this State.
I FURTHER CERTIFY that I have no intention to return to my former dotnicile,,and I intend to remain
• ~WALTON) FT. PIERCE ST. LIICIE '~ ______County, Florida,
(city)
permanently. -
.- ( saw)
r.
vorn ~' s~~ before me thia__ 1st _--day of
- rs ~ ~ •'
'-~tsn la ~Pt,RT~~G•CLERg CIRCIIIT_ COIIRT
..- • ~ID
__".ROB-I.._ A~ gE>DL_-----------------
(Address)
DEP. CLERK
(1b be ezeented in duplicate and on pled with Clerk Circuit Court, and duplicate with Ta: Assessor)
Rnw~n BuDD17 (~0.. Plant C1t7. Pls., ~