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j~i 17 ,.275
Declaration of Domi~iI. and CitizenshiJt.luClE COUNn. fLA,
TO THE STATE AND COUNTY TAX ASSESSOR,
St. Wll. COUNTY, flORIDA:
This is my declaration of Oomlci'- llM CltlMnlhlp In the Stat. of florlde tt...t I MT\ filing this ct.y In acxlOtdenc:e,
and in conformity with C".hepter 222, Section 222,17, FIoride Statutes.
,
I was formerly a legal r.ic:Mnt of -; ,
M.ull1ns~
.__._._ ___ uSputh.-CUollna.--'--
CClty) ~
and I resided at___, _, _____ 4.l2..S.aabold Ave. - ---
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___ . However, I hew changed my domicil.
,
to and am and have been a bona fide rea!dent of the St... of florida slnce_~, . -.- l~tih --P -- .'-- __day of
. August. __ _.. _, 19 61, and I reside at '
1203-.Av.e..-E..-----.., ______u_
(IIrMt and ~)
Ft.Pier.ce,
(CIty)
._ _,p' -:...--..St..Lucie- ,--. ,.-- .. County, florida,
. .
and this statement is to be taken as my declaration of citizenlhip, actual legal residence and domkile In the Slate
of florida.
n-t her. .., ~ fecta. wch . .... of ~ or ...... or ~ 01 ........ .. -- ......
~el of fenlly to ... ....... Purd-e of ..., etcJ
Entering Argie Ann in Seventh Grade
'97783
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. ,,,' "~"'. \96\ AUG 29 An "
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" "-:\"f \oJ floul~
' .-- I. ':'::,~'~' ; <'.,. ,,\ \. st LUCIE COUNll. . t\
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I FURTHER CERTifY that I will registtit at my local address when the registration boob reopen, and comply with
all other requirements ~ a legal resident 'of this State. .
I fURTHER CERTIfY that I have no Intention to rerum to my former domicile, and I Intend to remain In_______
_ d_ . _Ft. Pi.e,rc.e...
(City)
County, florida,
permaMntly,.
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. '..Swo'rri'to 5l\d"Jubscribed before me this 29th- day of _,________J.ugust.- ---- ----. -, 19. 61
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. l. 'J R .. ..E01.TRAS _ ,. _, . _ ,. _, __ _._ __ ~ ,_ '. _ _ _ _ __ ,. _ _ u. _ _ -, --., -. .. - - - - -- - - - -. - - - - ,- - - - - - _ , . .
, .",....\ 'ROGER POITRAS, CLERK CIRCUIT COURT Notary Public
~ _ --.t~~ -- - c~_ _;. _ D.C. Niy Commi..ion .x..... -..-. -- . --- -- - - -. --- -.
(Heme)
,_12.OJuAve___-F.,.-Ft..Pi..erc.e ~ Florids
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