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Declaration of
Domicile and Citi%ens~~~ 8 12
ST. LUCIE CCLJNTY, flA.
TO THE STATE AND COUNTY TAX ASSESSOR,
S~ VJ.oie
COUNTY, FLORIDA:
This is my declaration of Domicile and CitizeMhip in the State of Florida thllt I am filing this day in
accordance, Lnd in conformity with Chapter 222, Seetion 222.17, Florida Statutes.
. , Shettie11 Lak6 Ohio
I was formerly a lepl resldent oL_________._____'m___ _________,___________,._____________00_________', ---------------- ------------ -- - ---..-
(City) (State)
and I resided aL_ ____4.l38,_,B81~__AyellU.8m____.m_..__ - '. However, I have chaIlged my domicile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since 11 ,day of
___~Ft!______________m_____m____m___' 1S____~~, and I reside utm__~?__~_~___~_!:I:~~~_~~_~_t__ .----'----' __m_'_ ._____._m -.
(Street and Nucber)
Fort pierce St. Lucie .
__________________________________________________________'_', ___n___ ..___ ____m___________'_'___ ,_,___,____ ,___,__________ 00_ ,County, Florlda,
(Cit}')
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida.
(lnMrt here any pertinent facta, IUc:.h as "Ie 01 property cr bu&ineu. or relinquishment of employment at
former domieile, rem07al of family to new domleile. purchue of home. etc.)
Entering Debta Ann in 1st Grade
93982
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FILED AND REC OED
IN _BOO:
1961 APR' I P~ 12: 2 ,
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I FURTHER CERTIFY that I will register at my lc,cal add1'e88 when the registration books reopen,
and comply with all other requirements of a legal resident of this State,
I FUR'I1IER CER'f1FY that I have no intention to return to my former domicile, and I intend to remain
:-':-O~_P1(=}e_____. ~J5;:?L::O:_d~'
(Name)
Paul Donaldson
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(To ..... eXecuted hi dupUcat8 aDd oriJ'bW fUed wiUl Cletk Clrt-ult c.ourt. aDd ctu,lieat.'with 'Tu Aueuor)
R6_ .."Ill)' Co.. J"taat at)', ria.
Sworn to &nd l\<bIerib6d before me thia___.lA-.____day of
April . , A. D. 1961_.
Boger Poitras ,Clerk of C11' :ui t Court
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