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~o~~ 5 555
Decl~ration of Domicile ong t4iti'l..rsid~.
'fO nIE STATE AND COUNTY TAX ASSESSOR,
Sa:i.nt Lucitt COUNTY, FLORIDA:
Thi~ 18 my declaration of Domicile and cttheu.hip in the State of Florida that 1 am ftlin~ this day in
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accordance, and it> conformity with Chapter 222, Section 222.17, Florida Statutes.
1 W[l8 formerly a lepl resident oL__..__K.i_m~~~m___,..._,_____m._.._mu_____, _____nm______~_C!~~~___~.~_~,olina
(el"') (State)
and 1 resided aL--, ____ J1~.____W,~.~_~_y~:r.!l,C?fl__Ay.~,. .__,___h' ,,,,- -----. However, I have chan~ my domicile
(Street aDd N umbar)
to and am and haye been a bona fide reaident of the State of Florida since____.., j,5~h,_______.__u_.., day of
______f.~,~!:~.~!:J.m__'__.___.__m_____.__, 19 _~~, and I reaide aL.___~.~~___~_~.~~n uDr~Y_~_--_u_.__m___u.____m_m_u__
(StTeet and Number)
..~.~:-~, ,.~_~.~~~.~-.-.---.__---.m- __u______._.__.,' _m.__u'___ _S_t..Lu.c1.e---___---.-------.-.--m-COu:lty' Florida,
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and this statement is to be taken as my declal'Rtion of citizenship, actoal legal residence and do~ieile in
the State of Florida.
(Insert here ;illY pertinent facts. luea lU! ..1. Ofpl'Ope~t~r auainua. or nlinquiahment cd eJI1p10)'m8llt at
former domicile. removal of family to new domicil.. po . cd boaM. ,".)
Entering Rose Marie Freeman Bnnan in the 4th grade
n Betty Joe Freeman in t he 2nd grade
93070
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FlLEQ MiD RECOf\DED
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ROGER POiTRAS. CLERK
~ i. L!. ('TOO ii I; T f, r L 0 i.: [I A
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I FURTliF~ CERTIFY that I will register at my 'ocal address whe!\ the regilltration books reopen,
and cOr-lply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my 'crmer domicile, and I intend t.o remain
. Fort Pierce St. Lucie Count F10rida
lD..n_n____ _n___ _ __ ,_m," .__' n_' _.n __ __on _ ,_, _.___n.' __n_h_nU.n ,uh ____n, ._._ ___nn _nn____._ __n_n_h__' __n ,-- ,___u.__n._ --- nY' ,
pennanently. (City) .L~._~--.-n--,-m--'--n-----m-
William Freeman(Nvne)
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(Addrell)
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M Co ..' Jan 1~ 1964 ',.:'~, ,:,.,," ',.',~,:
y mn:ugalCD expll"eS_________,_______~.:-, . "-'" . ,,-~(, "
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(Tel 1>6 exeeuted in duplicate and oripw talfll with C1eritctreiBt->Co\U't,'~ npUeate with Tax AlMUOr)
Swum to and Ilubaeribed before me this__..lJ._,daY of
Z--_. ~r,c!Lon.___h__'_'________.___, A. D, 19__61
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Nutoo'Y Pul>lie State of Florida at ~
Rn.....n BaDDIT Co" Plant ClIy. "'Ia,