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i~U~~~ iti p~GE 490
t . '-...,,-- A
Declaration' (".~f ~~P~il~ ~ ~~d Citizenship
.,..-
TO THE STATE AND COUNTY TAX ASSESS<>,R.
__ ST au LUCiE.
COUNTY, flORIDA:
Thj~ i~ my dec~tion of Domicile and Citizen~hip in the State of Florida that I am filing thi~ day in accordance,
ane! in conformity with Chapter 222, Section 222.17. Florida Statute~.
I wa~ formerly a legal re~ident of
LOUISVILLE
KY.
(City!
(S'.',!
and I re~ided at ' 3815 Mich. Dr~ ve.
(S'r..' end Number!
However. I have changed my domicile
to and am and have been a bona fide re~ident of the State of Florida ~ince
11th
day of
JUNE
,19 61, and I re~ide at
1007 Yark Rd.
(S'r..' .nd Number!
FT. PIERCE
ST. LUCIE
County, Florida.
(Cily!
and thi~ ~tatem~t. i~ to be taken a~ my declaration of citizen~hip, actual legal re~idence and domicile in the State
of Florida.
(In.." her. any per'inen' fech, .uch " ..I. 01 properly or busi...... 0< r.llnqui.......nt of employmen' ., for..... domicile,
r.mov.1 of f.mily '0 new domicile, purcha.. of home. .tc.)
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mTERING TWO CHILDREN IN PUBLIC SCHOOLS
NO~UN ROGER BISHO P
TBO~~ LUKE BISHOP
16yrs
9Yrs
975112
fLEe ~.NO P.ECO?OEO
A:J 'A~J'" ..., fllV
It.'af.f(t I'/,{ B'!!{wur.: JJi\
l~S' nUG 21 pr 2: r)1
Sl, LuciE :~~~N:~'~jlO:~;~'~
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I FURTHER CERTIFY that 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.
FURTHER CERTIFY that I have no intention to return to my fOimer domicile, and I intend to remain in_. - --
FT. PIERCE
ST. LUCIE
County, Florida,
(Oty)
permanently.
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SWDft,~...nci~~ ~ore me this
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JEAN T. BISH Of
(Addr-)
21st
AUGUST
day ot _ - - - -- - .. - -
61.
., 19 .
By
COURT
-- - - ---~---------
Notary Public
__ D.C.
My Commission expires.
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