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Ib!i 18..253
Declaration \..fu~_. f'Qnd Citixenship
TO TI-* STATE AND COUN1Y T~.X ~,
_~__.s.t.. Lu.c.ia.__~m~_COUNn-. FLORIDA:
This is my d<<1"r.tion of Domicil-tl and Ci'il~!hip in thos State of Florida tn.t I am filing this d.y in KCO.rdotnce,
end it": conformity with Chapter 22'1, SectkK'l 221.17, Flcrlde Stlttvtet,
! .....as fOflTW!'rly I legl.ll r!!tllmnt of
Iiunt.ington
New l.ork
~l
(1;ity)
llnd I resided a'
Cove Road
l'5ll'M' ...... ~)
However., I havl/!! cn.nged my chmiel~
to and am and hove boNn '" bone fide ri!sicUtnt of the ~t.'e of Florida sinee.
1st
day of
November
. ,19 60, and I 'r"tSide at
515 SQut.:._1Qth-....it.reet,
~, ...... Numb.<)
Fort Pierce
(C~'Y)
St. Luci.e
Coun~, Florida,
and Ihis stalernent i:l to be taken as my declaration of citiUtnthip, ~-'~! !~! r~!d~~ ~-.d dom!dle in th~ St.;h~
of Florida.
(I...." ...... .ny perli.....' fKb, wch .. ..,... of pr~ Of bu9l:_, Of r.UnqvW>ment' of ....loynwnt .t formet c!omIcll..
...-.1 0; Cemlty ~ _ ~ ~ of ~. -.)
Establish residence
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>~t\l\~ota 8,'. 'Y,
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p.nGER POIT~A~: ~k<~'.
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I FURTHER CERTlFi thllt I will register elf my !ocal Clddress wherl the registration books reopen, end comply With
ail oH'ler requirer;)ents Of II le<Jal reSident of this 5tate.
I FURTHER CERTiFY ttHlt I have no intenlion to reilJrn to my ferrner domid!e, and intend to remain iil
For t FiE' r r; e
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CO-.;ntf, r'k.rida.
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