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~~ IUCIE OUNTY. F A , , •
Daclorot:on clf~~~omicile onc~ Citizenahlp
TO THE STATE AND COUNTY TAX ~SESSOR,
St• I.~ic;i~ COUNTY, FLORIDA:
This is my dadaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance,
and in conformity with Chapter 222, Section 222.17, Florida St~tvtes.
SHEFPTEI:D LAKE
was formerly a la~si resident of _____ __ __-~~~_---------- ----------. ___DhiO-------------
lCihr) W.~
and 1 resided at-------31.E--C~ e-~$s ~~Y~-------------------'. 'Howawr, 1 haw charged my domicile
to and am and haw been a bona fide resident of the State of Florida sinoe____-- -1$.th--------------day of
----- --~--p ------------• 19_4-; and 1 resale at __~.~~ ~._ CemiD.a.~SS.tes~,---
t>e..r a#d ra.•e..1
Rifer Park, 1~t.Pieree, Floridl- -
-r-- ---- -------- ~tY• Florida,
and thh statement is ib be taken es my detixation of dtixer>s1Np. ~ctwl legal residenoa and domcile in the State
of Florida. -
pw.vt Mh snr a«~M.sr tcrM. wd# a s•M of paMrb ar 1wNmw„ a-nWMuNM~wM ~ +~ tew~K dade>i•,
rws~rl of i~llr Ic prMr ~~ ~~ at M*.. ~J
Rf~D~D
~Ni1 _ -
. - ~ , ; :. ` 1962 JAN •3 AM 9: 5~
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. -~~ ,~ t •. • ~~•_--•.• ~ "220 hl.'QasinO S~,Fti~Pf srb*,Y!i~.
"'"% t,~i subscribed before me this-- - - 3rd------- ~y ~ ---d1lDLLBtY-----=-------------. »r~-.-
------- R~GE
BY
a~oo. R. •#c~oc
CLERK CIRCUIT COURT
________ D.C.
Notary Public
MY Commissbn. expires
Re M ..•ard tw ~IkaM M/ •.yM.t ttl•i rMU Ctrk Ctwil Ccwb •a/ ~w+ crMl~ T•s AMw•et