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O. R.
BOOK
1'/6
6
Declaration of Domicile anI ~Wi~~lprLA.
"--
TO ~ STATE AND COUNTY TAX. ~R."SOR.
St.Lucie COUNTY. FLORIDA:
Th1a Lt Uly declaration of Domieile and Cltizenahip in the Statt., of Florida that I am tiling this day in
accord~ce, and in conformity with Chapter 222, Section 222,17, Florida Statutes.
1 wu formeriy a 18181 reaident of____Veathers..field.---'----n------,----------' ____~_Conn....___",...___..h______
(Cit,.) - (State)
and ll"Mided at...,,__,14Q..So..Wel.L.Road.--.,--,-....m----......,..,., However, I have changed my domicile
(BtrMt ADd Number) _
to and am tmd have been a bons fide resident of the St3te of Florida since..__, 19th :" ......... day of
_n:Q_~~~m ~e~_____,____,____"_"_:...__, 19,.__~_~ and I reside 8.t,___l..l2mW.il_lO.WLAY,~..., _Ri__YJ~r ..P~,r.l<n___.."_'..,
(Street and Number)
______', _________,~.~_. L'!:,ci ~_____~~,___"n__.,_h___m_____..COunty. Florida,_
Fort Pi erce
(CltJ)
and this at3tement is to be taken as my decl:u'ation of citiuD.8~1ip, actual legal residence and domicile in
the State of Florida.
(lntert bere an:, pertinent facta. ~uch as &al. of i'roper..y or buaineu. ~_nllnquiahmeDt of employmmt at
former domieDe, nmonl of family to new doml:Ue, purehue of hom., -.)
----
Establishing residency
. : 'it '/':' .'
93286
FILED AND RECORDED
IN.9r<"'_~ -~CQJK
I~ MA~ 2() M1 J: 1,2
ROGER POITRlS. Clr~~:
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1 FURTHER CERTIFY that I will reai8ter at my lucal addrosa wh~n the regiBtration boob reIJpen,
and comply with all other requirements of a lepl resident of thia State.
I FURTHER CERTIFY that I have no fntenY.ion to return to my former domicile. and I intend to remain
ill J.oIt.t...Fi 81'tll,)
~. .
Swon: to and su~ before me thia_.....2Qt;.y of
_ ~.;"r\llar.ch--------i A. D. 19....6l.. .
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