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Declaration of Dom~ile and ~i~zenship
:o~i
15 PAGf2J7
TO THE STATE AND COUNTY TAX ASSESSOr.
St. ~cle
5 T, LUCIE COUNTY. flA.
COUNTY, RORIDA:
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This Is my declaration of Domicile Md Citiunahlp In _ Sq.. of FIoride ..... I em flUng this dey In MIClOIdence.
and In conformity wtth CMpter 222, Section 222,17, fIorid8 S.tute&.
I wes formerly a 1.1 ,..ldent of. ,_., ...t_.Ql1.caga.__________.._________, ,___I_ll1noi.JL______
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end I raided at . 55 ~,o.l,~_~~~~~__.. __.___,___'_______ ..'---, HooM.'IeI',1 have changed my domicile
cser-t .... .......)
to end em and hev. been e boN fide raldent of the Sta.. of FlorlcM slnce__, __ _ _..l1_________________dey of
___July ,
...19 .6l" end I r-.ide 6t . ...29.30_.H.lL_l.edaral.-Higbway-----
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Fort Pierce
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(CIty)
and this statement is to be taken as my declaration of citizenship, Ktual legal raidenat .nd domicil. in the St.te
of Florida.
St. Lucie
.. _ County, Florida,'
<'-t her. MY -**" fecta, IUdt .. .... of pnIpeIty << ~ << r............. of ......--' .. -- ........
_.I of femlly to _ damkIIe. ~ of .... eIC.)
Entering a_"- - Deborah Schroeder in 2 nd Grade
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I FURTHER CERTIFY that I will register .t my local address when the registr.tion boob reopen, and comply with
.11 other requirements of a leg.1 resident of this St.... .
I FURTHER CERTIFY that I have no intention to mum to my former domicil., and I Intend to remain in - - - - - '
_ Fort P1er..cs.___, --.--.
(C1tyl
_ n~t......._Luc1...________ ____ __' ,- County. Florid.,
permanently.
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.&SlL, LerOJ_L:..S.chr.o.eder. __H .
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Sworn to .nd subscribed beforo me this_
3~.--'n. day ot ________,,_.J.u1.J_,______ ___..,19_..61
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By .CC~.;Z~':~~T.~=~~ D.C.
Notary Public
My Commiuion .:<pires _. __ - _ - __ ____ - - ----.. - - ___n
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