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~ao~ 26 P~cE1'76 ~ .
Qeclaration of DIbQOi~Eil~u~c~l~itizenahip
TO THE STATE AND COUNTY TAX ASSESSOR..
COUNTY, FLORIDA:
This is my declaration of Domki{e and Citizenship in the Stets of Florida that 1 am filing this day in aooordance,
and in conformity with Chapter 222, section 222.1y, Florida Statutes. '
Weat_Maasfield _ - Ohio _--
t woe formerly a IeRal resident of - _ _ _ _ - - - - - - - - - t~1
_ - - - -- - . However. I have charged my domkile
and 1 rei~ded at_-- - - Ro1~fic4_ 2 ____------- --------- --------
{Sf..a and N„w~ba.)
band em and have been a bona fide resident of the State of Florida since_____-_ 22___--~--------____day of
2 00 _S. _l~th_Street~ Serene_
---DeCemtl@Y' -------- --- - -- -- ---• 19 -- 61 and I reside at ---- ----~ ~..N .nd rinnba.)
Trailer Park FortPierce -_ St. Lucie
` --- --- --_ -------- ~ntY~ Florida,
------------------
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and this statement is ro I» taken as my declaration of citizer-ship, actual IeRal residence and dom~ale m the State
of Florida. -
pnrat twn anq perNnwM facN, avtA as nab of pop.rb ar braban. ar ntYqulat.~aM ~ e/1d°y"'~"~ a~ fornw dwnlcaa.
nn~svai ai fan~- b neMr alowiidla, purct+aM of haM, e1eJ _
Entering Michael Wayne Johnson in lest Grade
Was enrolled in York Center' School is Ohio
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1961 QEC 28 B~
AM10: 11
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i FURTHER CERTIFY that 1 will rpister at my kacal address when the registration books reopen, and comply with
all other requirements of • legal resident of this State.
I FURTHER CERTIFY tfNt 1 hew no intention b return b my former domidle, and (intend- b remain in------
Fort Pierce - St. Lltcie - - Amy, p~~a,
permanently.
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a+••~a
(Mrs) Ann Arthur
sworn b and wbsuibed before me th::_.:. z8 ____--- dw ~ ~----~~_--------------• 19__bl_
Roger Poitras - - -~'
_ ~~ ~k --------------
-------------------- ---
------- R -----------
CLERK CIRCUR COURT
Commisskxt ---------------------------
- - ---------------3 D.C. My expires
®Y ------- - - - - -
~ M aaMtaa~ r ~a1e aai/ wietgl !~e/ rtr « t~we CewR ae~ ~~ 1NM Tae Aaaaaaael
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