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St. Lucis couNTY, FLORIDA: •St. LUC1F COUNtrt FED,
This is my declaration of Domidle and Citizenship in the Stsh of Florida that 1 am filirp this day in accordance,
and in conformity with Chapter 222, Section 222.17, Florida Statutes.
Declorotion • of Domicile and Citiien:hip
TO THE STATE AND COUNTY TAX ASSESSOR, BbO~ ~ ~~~
1 was formerly a Isgal resident of . ____KenOahB _ - _ - ____ - - a1aCOnain
~)
and 1 resided at - _ _ . 6 •
?~5 _ ~1r t h A_v_eanue - _ _ _ _ - - _ However, 1 haw dha
(St...~ and I~N,w~b..) - - ----- -- - ---- aged my domicile
ro and am and have been a bona fide resident of the Stsh of Florida sinoe___-_ _ 1$___
--------------day of
---- -Junta-- - -----_-.--- -_-__-- _ , t9___61 and 1 reside at __ _--_1Ob. Camina_S~ss~,_ Riy~rr_ Part
tt~..~ «.a t~lu~ne.r)
Fort Pierce St. Lucie
--- - - - -- - - --_-__-- Comb. Florida,
(cer) ---------- --
and this statement is to bs taken as my dedaration of citizenship, actual legal residence and domkile in the State
of Florida.
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Applying for homestead
•~• _ ....r; .;~~~.
FlLED AND RECORO~OK
I '
1961 JAN -3 AM 10:58
ROGER POITRAS, CLERK
St. IUCIE COUNTY, FIORIO^^A
~t
.~ i -,~•1.. - c ~ , ~ .
-~ ~~~ .may f -
~~
1 FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with
all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return ro my former domidle, and i intend to remain in______
_ Fort Pierce St. Lucie
- ----------- - -- --- ----- ----------~ - - -- - -- ---- --- County, Florida,
tC~M
permanently.
-~~~2?~1~ytr~ --------- ----- --
«w.) - - -
_ ?~ _ !-~nthQiaX_DucQ------- -- -------
Sworn ro and subscribed before me this da of _ _ _ _ _ __ ,Iz~~
-- - Y - ---------------. 19__62--
Roger Poitras, Clerk
ROGER PO AS CLERK CIRCUIT COURT --------- ------------
Notary Public
BY --C~~,,.~ ---
~~~~~'^'i-------------- D.C. My Commission expires --------------___ -
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