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~iJ~~ 17 PAGE 114
Declaration ~f lDmrttilJite. q,,~ Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR.
_~~-!~u<:!~__COUNTY. flORIDA:
This is my declaration of Domicile and Citizemhip in the State of Florida that I am filing this day in accordance.
and in conformity with Chapter 222. Section 222,17. Florida Statutes,
I was formerly a legal rellident of
Hi;:gs
Louisiana
(S'.")
(City)
and I resided at.
Rt 3J3ox..123
(St,..1 and Nvmbet)
However. I have changed my domicile
to and am and have been a bona fide r.)Sident of the State of Florida ,ince leth ,
3224
Aueust . 19 .61. and I reside at e.4ft4 ;j~mrts_~__BJ, vd
(Str.., .r.d Number)
day .of
Fort Pi~rce _
(City)
St. Lucie _ ' County. Florida.
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State
of Florida.
(InMft ...... .ny pertInent teen. wet. .. .... of property cw bullr.eII. << ,.Ilnqviehmeft! of empIoynMnl .1 fonnef domIci"'.
remov.l of t.....1y 10 rtofNI domld... putd\ae of home. etc.)
Lnterin~ Juanita B. Ham in the 7th grade
97687
filED AND RECORDED
IN ~.I~/".I. As("IiP. nOOK
196\ AUG 2S PM 12: ,,.
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ROGER POIT(U.~, :l[r.l\ (L (J
ST. LUCIE COUNTY. fLORIDA~
I FURTHER CERTIFY th.t I will regist... .t m'l loc.1 .ddress when 1M registr.tlon book. reopen, .nd comply with
all other requirements of . legel resident of this St....
I FURTHER CERTIFY that I h.ve no intention to return to my former domicile, and I Intend to rsmain in_uu_
________F_o_r__t__P__i_e__r_c.e___ __________________ ,_ St L"ci e I
______._______~ _~u__ ._______._ County, Forlda,
(CIty)
permanantly.
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L _ .~.___L~'-- ~'-- -- -- - - -,
<N-M)
l<1rs. r.Uke l:!atson
----------------------------------.-------
(AcUnu)
Sworn to and lubscribed before me this 25~~~~~'1~';~ii1r..,~---- _ ~_~~~_~__________u___, 19_?_1 -.
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---n---ROGER-POliRAS,-ClERK(:;I~licol$i.~:r-:: ! ~1': ~:- --------N"o.;;y-Pu-bii;--u-----------
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:.-: ! " [ c i . '/: e. f NoUry PubliC. State of flonua ~ L~~~~
By ___.________________________~_______;.-~.d).<:. ~ My~s&.ion expires ~yJ~_Q~f!l~s~.9!1_~"':.!'.:r~~.:~~._~:._~_:\
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