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Declarotia~r~' ~~i~'i~~A'and Citizenship
TO TH$ STATE AND COUNTY TA]C A88Bi3t3OR.
~. II1Ca OOUN'I'Y, FigRIDA:
This is my declaration of Domidle and Citisenship in the State of Florida that I am ffiing this day in
accordance, snd in conformity with Chapter 282, Section 22`L.17, Florida Statutes.
I was tormer~y a legal residm-t of ___~_~ ~~ __~ ~~1_ .._.._~_
(Clb) (8tW)
and I resided at-_____--1~_ ~ ~~~ _ ---- - ------. However, I have changed a~,y domicile
---- -------------- - --
• (Strwt gad Number)
to and am and have been a bons fSde resident of the State of Florida since-a'~d----------------------------------day of
-- d~7 ~- --____, 18~, and I reside sa (~. ~ ~ lYa+r~ -.~- -
($tnat mad Nnmb~r)
gsq't P3arca __, -3ti.--Sine----- _ -------___..____County, Flonda,
SCI. t7~
and this statement is to be taken as my declaration of citi:enahip, actual legal residence and domicile in
the State o! Florida.
loran domkiN ~ ~ to z ~domidl~. ~archaso od~L~ ~~nlsLm~t a~ ~saDloym~t at
92'72'7
FlLED AND~R~ECORD/ED
IN ~i~~10UK.~/
1961 FEB 28 AN I I: 46 O
ROGER POITRAS. CLERK
ST. IUCIE COUNTY. FIORIpA
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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.
I FURTHER CERTII+'Y that I have no intention to return to sty former domicile, and I intend to remain
~ Faa~t PLroe at. Iuaie County, Florida,
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Sworn to and subsulbed beiie~s ' ~' -"-- (Abdew)
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eey~wa igM wki aMad~ Q~dt. Cwe< +rN 4~ wiRh i1~t ~M~we)
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