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D~larot~an Qf.~ ~~r~~~P
~St.'IUCIE COUMtY. flA.~
TO THE STATE ANO COUNTY T/1X /153ESS~OR.
3t. Luci • m,~tnr~ Ftt~RIDJ4
t
This is my dedaration of Oomidle and Cltiaertshlp In tM State of Florida that 1 am flllnp this day in aooordanw and
in conformlfy with Chapter 22'l, Section ~ZZ.17, Florida StahiNs. '
1~yirtiaaebur6 ~ wsat.~a.
was formerly a Ipal resident of--------------------- ~-----------------• ----------------------
- tts~
308 ~1. Team. Are.
and 1 resided at -------------------------------~
(i1~.c1 .nd t~hlslbcr)
-__-• However, 1 haw changed my domidle
to and am and have been a bona fide resident of the State of Florida slncs____-- 3~ ------------------- ~Y ~
July ____-. 19__ ~ and l resld. at __ 204 ~! _41st at~c'eet
------------------------------------ q«.n «la ~ ----------
--------- Fgrtt_Pierge_ ------- ------
taM
St.Lucie
County, Florida,
and this statement is to be taken as my declaration of dtizenship, actual legal residenos and domicile in the State of Florida.
(InNlt I>.n MY pKNnalt f.clt, wdl +a wM of prop.rty a twitrlw, a relMquWrn.eM of ellt}~orlw~IM M torwlcr dowlidM,
nwlovd of f.111Up a whw donikl4. pectin. of t1owM, Nc.)'
Establishing residency
F11~~ . E ~800K
R~
IN 11 pM 10: b9
1962.1
... :., aQ~EA p01 NR~ASE Oa pA
. ~ ~ ~ ~ • ~uC~E C0U
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,• ,.,: ~;
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..... '~~
.'„
I 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 Stste.
1 FURTHER CERTIFY that I have no intention to return to my former domicile, and 1 intend to remain in
Fort Pierce $t.Lucie --- County, Florida,
- (city)
permanently.
---- -- -- --- -_LB~lis~_-!'Y-----------------
Waw+.)
• Ho y Gainer
_,
.: :,,„~AI,~ Ily,tyy
i • ~ ... ... Y111 ~,~.
Sworn to and subscribed before me this --~lj~--=~~~ rt_~-b~~b~'ti~'-: -------~~~------------• 19---62
p ------------
- - - iT K CIRCUIT COURT y ~. ; ~ ~ (;) % ' ~, ---- Notary Public
,• ~ .
By -------- ~~,i ••.' ••'' MY.~tsontmiuion expires- -------------------------
Qw t» .psM./ r ic~YcM..w/ Mlelwcl Irc~ wM CINk cirlila C.wl. +~ ~~ orMl Tnl bnncd r.
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