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Declaration of Domici!e and Citi%ensh~,
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TO THE STATE .AND COUNTY 'fAX ASSESSOR,
St. Lucie
~, T, !, U(lE COllNTY. n A.
COUNTY, FLORIDA:
This ia my declaration of Domicile and CiUzenahip in t~e State of Florda that I am filing this day in
accordanc~, and in conformity with Chapter 222, Section 222,17, Florida Statutes.
I was formerly a lopl reaident of'______h.l.'R~,TlY'n__n_'__'________,________,._,__________,____,__, ______,N ~w__X.ort_______, ----,
(City} (State)
and I reaided aL,__ 467--Li vin~s,to.IL.AV.enu.eh____ ' . However, I have changed my d:>micile
(S-treet aDd Number) ?_
to and am and ha"e been a bona fide reaident of the State of Florida. since - I day of
______,De.ce.mbe.r________nm_______.___.__" 19..60, and I reside ut __,___,_____,~~g,__~,~~,~:.. ~---~~!! ~,t___~,o~,~___~t ,.___,~~,c i e
(Street and Number)
Fort Pierce St. Lucie ~ 'd
_'____________'_______h________'__,_____________'______________'_', __.__________h' , ________,_________'____' ,h__"'__'__ ____",'u __ " County. orl a,
(City )
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile In
the State of Florida.
(inlert here any pertinent facu, aueh ... aale of property or buaineaa. or re.linquishmer.t of empll)yment at
former domicile, removal of family to n.w domlc:U.. pureha.. of ho~ etc.)
Applying for homestead
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I FURTHER CERTIFY that I will regi!ter at my 10"-81 address when the regi8tratic.n books reo~n,
and comply with all other requirements of a legal reeident of this State.
I FURTHER CERTIFY that I have no intention to I""tum to my former dcmicile, and I intend to remain
Roge4' ~oi:.tras.._ (ae!'k of Circuit Ccurt
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-F.o.r..Lfci:~ tl --------.--, ____._~__Lu.c.i.a.___'___m__._______ __ County, Florida,
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_.~~ward _h!...~.?l~_______u___u___.__,_. u_'_'____._
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(To be eucvt..s m clupl.t. ud oricbW ftltd wWl a.rt Ctmrlt Court., aacI ~tti';ntJI. 'Tax A....-or)
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Swam t,{\ and aubecribtd before me thia--ll___.day of
___Marcl\ , A. D. 19-61
in