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Declaration of Domicile and Citizenshi~~~
<:,T. LUCIE Clu~nr\ HA,
TO THE STATE AND COUNTY TAX ASSESSOR,
5T. LUCIE
COUNTY, FlORID.to.
This is my declaration of Domiciie and Citizenship ir. the State of FIC'rida that I am fdiOlg this ~y in accordance,
and iOl conformity with Chapter 222, 5e<:tion 222.17, Florida Statutes
I was formerly a legal resident of
ERIE
PA
(stlt.)
(City)
--
and I resided at
3 1 $ \'1. 10th 5 t
However, I have changed my domicile
(S'r..' Ind Number)
to and am and hdve been a bona fide residen! of the State of Florida since
15th
day of
APRI L
, 19 61 ,and I reside at
1019 B Chipola Rd
(SlrH' .n::l Number)
Ft. Pierce
ST. LU C I E
County, Florida,
~C;ty)
........"
and this statement IS to be taken as my declaration of citizpnship, actual legal residence and domiC';te in the State
of Florida.
(In...rt her. an.,. perl io.en r f.ctI, luck I. .JlI. of property or bulin.u, or relinquishment of employ~t II former domicilf',
r.mo".1 01 hmily to new domicil., pureh... of home, etc.)
. .
.
<i
-, :,'.
942~3
f~~ ~~O OJRECO~OEO ,
\N~"MJg_~_BOO.
\%i APR 20 nl.1 \ \: 03
.. -. r ~ ..
~\.~'l"U~~~ rC%~~~'~: 'f lQl~ili'i ~
- --t" '
I FURTHER CERTIFY that I will register at my local eddress when the registration books reopen, end 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 domicile. and I intend to remain in,
FT. PIERCE
ST. LUCIE
, County, Florida,
(City)
permanently,
eg;y~':;;Tk
~ l (~
. __ _P. S_ STDUGH
(Addr...)
.~\\\l' C"..
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- . .. ~ t... ~ \ e,
: ":.' ;"6WC)ln to and: ~~scribed before me this 2Oth._,.
. ., ',.. I ~ .
~ ' p,.
lfl"' , fJGER: PO!~
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'-:'(~':"~"'- "R6<*'l~~S ClERKC'----- C'OURTh---
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'. .../......., - ..\" .
"~.'- ..'
."'f. - -
. ,
. day of __ ~RIL.
,19 61
,--, -----~
WIUXXU1~J. --,-.
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.~OD. n. Pllu.elf