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R~lph L. Orraho\)d
DeclQrctio~ of DoD'icHe and Citizenship
ib~l
sT. LUCIE COUNTY, rL~.
TO THE STATe AND COUNTY TAX ~S8ESSOR,
~Lucle COUNTY, FLORIDA:
ThLi is my dec.'laration of DvmleUe and Citiunahip in the State of Floride. tbat I am fllinr thia day in
acco:-dance, and in conformity \>tith Chapter 222, Seetion 222.17, FlQrida Gu.tutes.
I was formerly a l~ r.J3ident of.__~1_:~J~Et.9.11.______..__.________.____._________m_____.' _n___J[jrA!r.Q.-~-h----------
. (C1tJ) (State)
~nd I resided aL.. 4723... S.._.3ls:t..Str.eat.__________.____ . ..__. HClwe,'er, I have cha.ni'ed m.y domicile
(Street a.'\d NUlUber)
to and am and have been a bona fide resident of the StAte of Fiorida since ____..~Oth ...-.-.....------ day of
___.____S.ept_emher--------u--------.---, 19_60., and I reside at.____u.___2.'lQ5_._~ander_._AY..e.-----m---m-.--m.-------.
(Street And Number)
___________. .E_ Q~_t.__P. t.~ rg~_______________m__hh___.' ___h. .S_t_.. ~\!Q...:Le._____________m____. ______ .____.County, Florida,
(Cit)')
and this statement is to be taken &8 my declaration of citizen8hip;"actual legal residence and domicile in
the State of Florida.
(Insert bere any pertinent facta. aueb as 6&1. of properly or buaineaa. or rellnquiahment of emplo)'mat at
former do~ieDe. remoTal of family to n.w d\lmlell.. purtb... of ho~. ete.)
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195\ iinR-6 A)":II:?4
ROGER POITRAS. CLEP.K
ST. L!J~I:- CC!~tln. aOr,10A
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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 CERTIFY that I have no intention to return to my former domicile, and I inttad to :remain
. Fort Pierce
lll.______ ___n_m____ _.___. ___ _______un______________ n_____ --- .----------,
(City)
St. Lucie
_____________COunty, Florida,
------------------------------------
permanently.
/i1;-- ~!t___i__OJl.&~~~ti~---n---n.----m---
, (NUN)
Ral h L. Orrahood
__. .___.__________._ ___. ...___ (A~;)--n------. __________.n .______n
.,."
Sworn to ~..ub~bed 'b4dore me this____9_thuday of
.~. :\ ..... ... .,'..: -.-:' .
Marah ~.' ..-..-' - '.' 61
/___ =__,:~~:~~::.' 19-,
~ .. ':":, _' f';':" - 6:21L.~;_m-__-----.-
Mv CoIl111liaaJot\.~-------~---- --------
.. - :'Jill'.. ~' .... _ -
(To ~ -exet:'Jted in dUJl1i~te and oririnal i\led with Clerk Cirtult Court, and duplleate with Tax AlMUC'r)
So_ laP'" C... P".allt ctl,. J'1a.