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Declorotio ST. LUCtE tOUt~TY. FIA.
TO TFIE STATE ANO COUNTY TAX i1SSESSOR, _
St a.e~ e - ctitNTY, FIORiDA:
This is my dedantbn of Domicile and Citiaanship in the Sh» of Florida that 1 am filing this day in aooordana and
in conformity with Chapter 222, Ssctton 222.17, Florida Statute.
was formerly a legal residar-t af--------~~~Q---- ~-----------------• -----~~~.~~a------
ttaaa
___-. However, I have dtiarpsd my domidle
end I resided at ___-------- «~,d~~ ~~~--------------
to and am and have been a bona fide resident of the Sta» of Florida sins-----1st-------------------- daY of
_ ~ ------___-, 19_6]._, and I reside at ___BOllte-2a--$~c1IIl1Z_____--
-.auguaL--=------ ~...~ .~a ~s..t
------------------~ ~ ~--- - -- st - -lucid---------- ~n~h~, Florida.
•nd thirstatemsnt ~is to be taken as my declaration of dtiaenship, actual heal residenos and domidle in the Sta» of Honda.
- p~wr1 hae. anjr oaAYnnt fact. weh w wM of proparb ar biw~~w, a nlMquWmn~M of a.aployn~K at fanw doh
removal d fanrlY b naw- donAcN.. Purclwa d tgwa, ale
Satabliah Beaideac~
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1~9i~~dRl~ -:'r~M°f't'' 30
ROGER POITRAS, CIERK
. !T. LUCIE C/UHT , Fl®RIOA
1 FURTHER CERTIFY that I will npister at my local addnst when the registration books reopen. and comply wfth df
other requiramanh of a legal resident of thh State.
I FURTHER CERTIFY that i haw no in»ntion to return b my former domfdle, and 1 in»nd to amain in
.,, ~ .. _ fort Pieraa gt, La~oia _-- ca,my, Honda,
......
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N»..<....,..w-~ ~ ~_~~-_ -may ~ _!~~.- ----------~ 19---
Sworn toand subsaibad bafow ------- -- _.."-"-.'-
-- ~ CL~C QOl1Kt . - ...r.._.. -------------
~ --------~~-"-c _........__ DEC. AAy Coen+tiwlon ~k+ti-_-r-..-_.-- ----------
~. a M ww~M • ~M/ aril .~Rt ~# e~IM alli ~i~ReaR Grf4 aaf ~Iw ~ ~, ~~ ' .
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