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Declorotion c~~~liuol~i~~~~jtizsnahip - ~
TO THE'STATE AND COUNTY TAX'ASSESSOR,
fit. Luais COUNTY, FtOR10A: ~ `
This is my declaration of Domidle and Cltizartahip in the State of Fkxida that'1 am filirt~ this day In sooordanoe and
in conformity with Chapter 222, Section 222.17, Florida Statutes. _
1 was formerly a,legal resident of______________________- --------------____-, ----------------____--
tbhr) {tom.)
and 1 reitded at -- - __-- __-- _-- -___--- t--=---------------------------. However, 1 have chsrgec! my dorrtkile~
t>itreN +ed tewnher)
to and am and have been 'a bona fide resident of the State of Florida since_______1-'~____________________ dsy of
-------~~-----=-------------------------, 19__b1., and 1 reside st ________~~~)i~~0o13Ag--~4.~
RrreN «+d t~wwber) ~_
Fort Pierce _____~L~~iaicis:~________________ county, Florida, ~ _.
and this statement is to bs taken as my dedaration of citizertship,.ectual Isgal residence and domkila in the State of Florida.\
(Invert here any pertiwnt tecu. such p ~ele d property or buNenf4 or relirquhMnia et ompbrrneM M Conner dpnic{le,
rewwvd of few+ily q new dpnfcile, pwcheee of how»..tt.)
- ~~.
Ir[r. B>tllock has been Korking overseas for the past seven years in
Spanish Honduras.
He intettb to make Fort Pierce his permanent hose.
101724
M~f A t~oois-8001{
1961 JAN -9 PM 2: 16
ROGER POITRAS. CIERK
ST. IUCIE COUNTT. FLORIDA ~~
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I FURTHER CERTIFY that 1 will register et my local address when the registration books reopen, and aorMply whit ell
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
-__F~rt Pi~rce_-- - - __--- _ _ _- - St_e_Lucie___----____----. county, Florida,
+~ ~-r 'Q
..: •' ~_
- • ~ +~ r - ~ ~~ ~ '~ Robert Cro:~'s ey Bullock
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'~f ~,, ,;," ~ J anuar
Sworn to art~~ubscribed before me this --_~--4- _----_ __ -- -dsy of .-- _ __ -- ---1-_ _ _-- - - - - -_-__-- -- -, 19_ _ 62. ,
Roger Poitra,a, _ ~le><ic __ _ "____ _ ______ _ _ -
--- - - ------------------------
ROGER POITRA~LERK CIRCUIT COURT Notary Public
By (~~~lfiN~ ~---------------- D.C. My Commission expires--------------------
Rw M ~weastd iw Irlkww ew/ «yicot lied wM Cbrk CbeA C.wt, ewA ado ~rMA Te: Meewt)
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