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diJ!~~ it) PAGE 481
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Declaration oJ. &~fM1~~' ~L~a Citizenship
TO THE STATE AND COUNTY TAX. AS5ESSOR.
t)T. LUCIE
COUNTY. flORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance.
and in conformity with Chapter 222, Section 222.17. Florida Statutes.
; was formerly a legal resident of
RIDLEY TO\\'NSHIP
PENN
(City)
(S,...)
and I resided at t-10RTON PCB T OFFI CE
(S".., .nd Numbeo)
However. I have changed my domicile
to and am and have been a bona fide resident of the State of Florida since
30th
day of
JULY
FT. PIERCE
. 19 61, and I reside at Plumosa Lane, Lakewood Park
(S'r..' and Numbeo)
ST. LUCIE
County, Florida.
(City)
and this statement is to be taken liS my declllration of citizenship, actual legal residence and domicile in the State
of Florida.
(In..,' her. .'11 pe,'inen' fech. .uch aI ..I. of proper'y or buline... or ,.Iinqui.lvnen' of employrnen' ., 1Ot'..... dOItn;cile.
r.rncval of f.mily 10 new dom;cil.. pure..... of home. .'c.)
gNTERING TWO CHI LDREN IN PU BIlIC SCHOOLS
DENARD \'/ILSON Yill NG 13 yrs
CHARLES WALTER YOUNG 9 yrs
. '. \ ~ .ti
F~r~ ~.\~m ~~CO~. OED
I~! 11fflc~{;~.u;..t~lK
I?EJ /lUG 21 ryl'! i: '5
ROG[R POITRA S ': .'- .
Si.lUllE COUNTY,llUI\ldA
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I FURTHER CERTIFY thllt 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.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
FT. EIERCE
ST. LUCIE
County, Florida.
(Cilyl
permanently.
~k-t~~. (: c-r~f
(Name) /
HERBERT A. YO G
.
,. .., '.. -, _. I
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....... " ~ ". .
V:. .J.,..'. I;' 11 "
<< : ~ oJ'
(Addr...)
...' "0.
..... .." 'I
Sw?r;:!~'.~~'.~V~S~ibed befOle me this
. I ( t') .
. ""R'otER P.OITRt'.-ClERK CIRCU
= By~1 'fM'~c .~
21st
day of
AUGUST
.19 61
Notary Public
D.C.
My Commission expires
.. ill ..""Iiute and ,,"-i...1 filed with C.... Cite..it C...". .... tlvplic... with Tn A......')
.peD. "T~ ~II:.CE