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.. ':T, LUCIE .C~UHTT, rJ.#,
Declarotior. of Domicile and CItizenShip
TO THE STATE AND COUNTY TAX ASSESSOR
St. T...ucie
COUNTY. FLORIDA:
This i8 my declaration of Domicile and Citlunahip in the state of Florida that I am ftlin~ this day in
accordanl'~, and in conformity with Chapter 222. Seetioll 222,17, F1orioa Statutes.
I was formerly a legal resident oLm'l'r.9"-~~.e.r.~._~:e.,~.~...........m..m..m,.. ...___., mn_.S~~.~~mg.~E.<?!.~~.~
P 0 B . 241 (City) (Dt4te)
and I resided at · · ox ....... ..................' ,. , However, I have changed my domicile
(Street ~d Number)
to and am and have bE:en a bona fide resident of the State of Florida since., 7 ...... ,.'... day of
t-i arch.. .' , 19,6.1. and I reside Ht ......!+.~.~.}~,...~~_h,~_~...~_~.r.,~.~~nm....m.... ........n_..'
(Street ud Number)
St, Lucie '
.._n..._........'. ........, ...... .. ...n'.'_.n......~..,........................... ~....,Co()unty, Flonda,
Fort Pierce
-.----- -----.-------
(Cit) )
and this statement is ~o be take:l as my declaration of citizenship, actual legal residence and domicile in
the State of Florida,
(Inaert here allY pertinent facts, auch ..a sale of property or buaineaa, or relinquiahment of employmat at
former domicile. removal of family to new domicile. purchase of home, etc.)
Entering Rona1d~i11inrn Barbare in 1st Grade
935G9
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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,
in.......,....Xort x~.~r:-~,,:,_...
( City)
I FURTHER CERTIFY that I have no intention to return ~ my former domicile. and I intend to remain
.._... ..~.~. ~., ..~.~~~.~" .m.'..'.',. ,m ,..... n" ,. County . Florida.
...9~u~:uL~ ~" ,6~~~:?<,jg~"::,~::n......... _.n.' ...mn"
(Name)
--- ---.--.----.,
permanently.
Sworn to and subscribed ~fore me this, J. 0 __ day of
_._..barci:. ' ~..., ...........____........ A. D, 19...61,
Th&,mas Earl Barbare
--- - ------.--.-----.. --. -----~ - - ~- -. ._---------. ..------. ----------- -------------
(Addrellf )
"':,.:::'."..:./ -
,. .'. ~",,\jj:)L.'...~ '.. .
:. -.... '..~,~ T':':~ <.... ..<.'
_. ...!'.., .":,..:.....'~" ",I,:. .
::; ,~" ::.'". :'
Rog:r :'''oi tr'lB, Clerk of ircui t Court
----------_...... - .-..- ~--- ."---------~--------~-_..._.----_._.----
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My ~:~-n...~.:,a~.:~~:--..:.-~~~.~;~ /f A!l (f .
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(To be encuted I.~ ;ll.lplicate ..rod oricinal filed with Clerk Circuit C(Jurt, and du;>licll.te with Tu Aueuor)
R........n 8UDDlv ('0" Plant ;'lty, Fla,