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D I . f D ) T.. !.UCI[ COUNtl. JJ..A h'
ec oratton 0 Omltlle ana ~ltl%enS Ip
TO THE STATE AND COUNTY TAX ASSESSOR,
ST. LUCIE
COUNTY. FLORID}.:
This is my declaration of Domicile and Citizenship in the State of Florida that I am ftlin~ this day in
3ccordance, and in confCJnnity with Chapter 222, Seetion 222,17, Florida Stati.1tes.
I was formerly a iegal resident of ,"
lXBIBI .AIill,URN '_'...n ",o.h",_n"."__,, _.' ..N..E1L ,YORK___, nn.___'_'__
(City) (State)
, . However, I have changed my domicile
and I resided at 7 Grover Street .".."m,hh"._".
(Street and NumbeT)
to and am and have bem a bona fide 1"esident of the State of Florida sint;e
25th
". day of
".,__,__uJ,uly, Uh' 19,60, p.nd I leside at...."19D5-"BostoILAveuue.,,uh___,h'm'.'__",..._____.
(Street and Number)
f Q.rtfli ~.:rC e, .n ._.,.__...,,"...'_m"_".,...,., hS_t..",Luci.emm'_____u..' .'_mo....________'..._ "m,County, Florida,
(City)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida,
(Insert here any putinent facts, such ail sale of property or buainEAa, OT rellnqu~m.Dt 01 employment at
former domicile, removal of family to new domicile, pu~hase 01. home, ~,)
"
~)3030
\. \..., ....
~;;:y~!
t't'" .... 11 '" \: 11
~
\ J
". --"
p -, :. ".... :.~ r, ~ ~- -. r' ,.
, -,
/.
,
- '\'..~.-,~~-
I FURTHER CERTIFY that I will register at my local address when the registration books reo~~m,
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 dom:cile, and I intend to remain
in._____F'()rt Pierc,e_"..~
(City)
........~~~~~J~!:B~
,,_ ",._n,...__" __ uh __, g, _,ud'_,d_dn"_______ ...". --... .m'____'....
( Ad<!reaa)
-....---_. - ...---- .--- ---.--------,
permanently.
Sworn to and subsui~ before me this,..21stday of
'') '-:'.:,...."., .
_,,_,,_H:\rch_....,:.,'~.:.._.l.._- _:: :. A. D. 19.___61
~ .'.:). ('.'
(; .. 'y ...
u-0" ~Pu~~:sio;;u 'm' ~f;"':.__m
My Commission eXpir(*L~:.-" 2~i6J.__.,__mm'___'__
(To be executed in duplicate and oririnal filed with Clerk Ci~uit Court, and duplicate with Tu Auenor)
Hn.....n 8UI.'Dlv ('0., Plant t'l1J, FIll.