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Declaration ~Domi(:ile and '~1izenehip
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. 11386f
TO TIlE STATE AND COUNTY TAX ABS&S!JOR.
ST, LUCIE COUNTY, FLORIDA:
"
This is Ill)' declaration ot DomicU. and ClUzenah1p in the State ot Florida that I am tuini this day in accordance
and in conformity with Cbaptn 222, s.etion 2'll,17, Florida Statutes.
I \vu fonnerly a lep1 reI1dent of
MIAMI
[City)
FLORIDA
State
and I resided at
375 N. ~. gOth St.
[Street and Nwnberl
to and am and ~l&ve been a bona fide raident of the S~t. of Florida -aince
'-
. However. I have chanied my domicile
14th
August
62
. 19_ --. anJ I relide at
day of
1102 Count,y Garden
[~treet and N\ll1lber)
FORT PIERCE, SAINT LU<?E COUNTY, FLORIDA,
and this ltatement is to be taken u my declaration ot citizenship, actual l~al residence anj domicile in the State of Florida.
[Insert here any pertinent facts, such as I3le of property or business, or relinqaishment of employment
at foaner domicile, removal ot tamlly to new domicile purchase ot home, etc,)
FILING FOR Ho~~srrEAD PURPOSES
lt386r
f\LED AND RECORDED
\N-OftWal1tecoIlL no OK
\963 Mnll -8 PM 4: 04
ROGER POITRAS. Cl~RK /
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I FURTHER CERTIFY that I will register at my loell.1 address when the registration b::olu reopen, and comply
with all other requirements of a legal resident of this State.
! FURTHER CERTIFY that! have no intention to return to my for~er d 'cile. and I U1tend to remain in
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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Il.tin..LU'_0 ". ~ ~J. 1 .' 1-' 'rl oW
[Addressj
8th
:lay ot
:~RCH
19 63
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Notary Public
D,C, My Commission expires_
[To be executed In dupUcllte and orl,ma.l rued with Cle.l'k Circuit court, and duplkate with Tax Ms~or]