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D~clarot~n ~ ST. LUtIE COUliTX. FLA.~~ P .
TO THE STATE /1N~ COUNTY TAX /~-SS~50R, ~ ,
St. Luci• crxtntTir, agtlpA, ~ _
Thls is my dedaration of Domldte and CMiaanship In the Stab of FlorWa that I am fillrp this day in aooordana and
in conformity with Chapter 424, Section 42.17, Florida Statutes. `
' Indiana
was formerly a Isgal resident of__-- a~ ---------------------r---------• ----------------------
tGM) mat
600 M 57th Ave. - --____-• ~~~, I ~~ charpsd my domkile
and l resided at ------------- ----- --------------------- -
(SNaat and Plw.bar)
ro and am and have been a bona fide resident of the Steb of Florida slnce_____3~h =------------------ day of _
- 1 O1 Ro al Pal® Noad
-----------J~ -------------------------• 19_ 6~ , and I reside at ---~ ------y ------------------
" - {tAraM and t~imbar) -
------F9~_.~i4~'~~ -------------l--- 3t~Lucie_..--------- ~+my, Florida,
taM .
and this statement is ro be taken as my declaration of dtizenship, actual legal residence and domicile in tM Stab of Florida.
pn...t I»n any pa.rin.nt fact, .vcA « wla of p.opar+y « tu.ln.aa, a nikpushrnaM of «nploym.nt at t«mar domidM,
ranwval of family q naw domidla, p~echaM o~ homes, a1c.)
Establishing residency
,-
... ~tIED ANO K~.t~R~00K
J;•. ~ ;~:~; ~ .1952 JAN I 1 PM 2:
•.
~. - ''. • ~_~ c ~ ROG ~ E ~eUNRY Sf16R10A
~.,.!•:
- ~~ .. ' 1.
•. ..• •.
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 Stete.
I FURTHER CERTIFY that I have no intention to return ro my former domicile, and I intend to remain in
~•ort Pierce St.Lucie
------------• --------------------------- ---- County, Florida,
permanently. j ,
!5O - e ~(it/ -
- ------------------~~-- ----------------
Beatrice Goodyear
.,`` .~,.. -'~ ., ---January-----------------. _-._
- .• .
.• . .
11th '~ Lc•'''•..i ;' ~ 19-b12_
Sworn to and subscribed before me this ---_ _ _-_ - ~-' ' ' ~~ ----------------- ---- • -
- . !•
----r--~- .Of --r,- -------
. .:
ROGER POITRAS - ~• ; , :; . --- ~ - ~ ~ ~ - -- --------
------------------ ---- t....~ '~~.~ ------- - - -
- -- - - ~ f, ::, j t ' . r ti !•1{ Notary Public -----
R POITRAS, C K CIRCUIT COURT ~ , ~ ~ ;t'• i : v ,
. -
' • .:. -- -
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t3 ~C, ~'~%...., ~~f~ xpira--- --- -------------------
(Te M aeceaNd M Ie~aN cad adalaal /Mad ~ril~ Ct«If' ~ba~it .E.a.l~ •d d~•s• arw Tae Aaaaant
veo, n. •~cwce _,