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BOCK
DKloration of Domicile and Clti%en~h.i~~IE C~IU.HY, FlA,
TO THE STATE AND COUNTY 'fAX A&ES3OR,
S t . Lu.ci.L COUN'n". FLORIDA:
This is my dee1an.tion of Domicile and Cit.f.unahi)) in the State of Florida that I r.m tiling this day iil
e,cc(lrd'\nee, &:ld in cOfl.1onnity with ~ha1Jter 222, ~tic'n 222.1'1, F!;:.:oidt Statu..
I wu fqrmerly a 1~J!t\1 ~d.nt of.__.~~_~.~~.~.L_.m _____....__..________________, ._____..K~.n~.~~.}cr____._...__.
~Cit)') (S~)
and I re8ided at.....__.... _..__.g~_~.~!:'~1D~!:.!-!~_IT__._._._..._______.h_. ._.__. However, I hp,ve changed my domicile
- (Street aDd Numboil')
to and am and ha-..e been a bona fioe re&ident t\f the State of Florida since .__.__. .___6.... .--.._____ day of
....___9.~.t9_b_~r.____..____.__m.m_..m_' 19____9.Q and I r~ide aL.._._..~95 _.~_~e~~~.~l_1.~!~_.~_~_!.n.~~_~.~
. (Jtreet and Number)
Fort Pierce - St. Lucie .
__._______...__..._._._.____ _.._____.. __no .__.___ _______...._________,...__.______ ,___.COunty, Flonds,
(City)
~nd this statement is to be taken &8 my df;Claration of citizenship, actual legsl residenee and eomicile in
the State of Florida. .
(lnMrt MZ'8 lP-JlY pertinent facta, aU<lA u ..1. of pro perl)' or bnaiDeaa. or nlinquiahment of employmel't at
f"rmtr do~i~U.. remonl of family to usw domicile, pureha.. of holM. etc.)
- Applying fo!:' homestead
92761
IN~~OJ~JK
1961 ri.QR -! M!! ,: 05
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,;:0 .;:. \J ........, " ,
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I FURTHER CERTIFY that I will reC1JSter at my loeal addreaa when the regi3tration books reopen,
and comply with aU other I"e:lu!rementa of a lepl ree1dent of t.hia State.
I FURT}lF.P. CERTIFY that 1 hav~ no intention t;..):eturn to my former domicile, and I intend to remain
t_ Fort Pierce St . Luci e
I.U -_County, P1orida,
)lOmWIelItIy. 1....1 -.:Jt_..tJ.4. U ~ ___-;-
Thomas
V.Roes..'
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Sworn to and au~:bed befO:t6 me thi5----.-..!.--da1 of
March . ~ D. 19 6l;
_ Roger Poitras. Clark ofC11;eu1tCourt
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(To hti tndltM fa ~te ud orip.,.J 4W wttl\ Clw ~ Covt......d ApUea~-~ 'ri:& A~)
Ro- !Jull""Y c... Pint ~Y. J'lol,