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Declaration ~~~~~.~~enahip
11386~)
TO TIlE STATE AND COUNTY TAX ASSESSOR.
ST, L'UCIE COUNTY, FLORIDA:
....
Thla 11 my deelaraUon of DomicUe and Citaen.hlp in the State o~ Florida ~lt 1. am filing this day In accord.ance
and In conformity with Chapter 222. Section 222,17. Florida Statutes.
I wu formerly a 1ep1 raldent of
"-
PO;\~ON LAKES
[City)
N. J.
Sate
3? Howard St.
[!ftreet and Nwn"'br.-]
to and am anIJ have been a bona f!.de resident of the State of Florida 11nee
ltu\RCH 63
, 19_ -. and I rellde at
Ilnd I reaJded at
. However, I have changed my domicile .
6th
day of
5?06 Ci truB Ave
[Street and Nwmber]
FORT PIERCE, SAINT LUCIE COUNTY. FLORIDA.
and this statement is to be taken as my declaration of c1tlzensh Ip, actual legal residence and domicile 1n the Stete of Florida.
[Insert here any pertinent facts. such as sale of property or b\ll1lness, or relinquishment of employment
at former domicile, remo\'al of family to new domicile purchase of home, etc.] .
EHTERI.i.'lZ ONE CHILD IN PUBLI~ SCHOOL
CHERYL LEE R01~R (l?)
1103869
fiLED A~D RECORDED
IN llHiciIl.Recmd.- 900K
1963 M~:l II AM 9: 04
ROGER POITRAS. CLERK V
ST. LUCIE COUNTY. FLORIOA ~t"1
JJP ~
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I FURTHER CERTIFY that I will register at my local address when the registration b:oks reopen. and comply
with all other requiremenu of a legal resident of this State.
I FURTHER CERTIFY that I heve no intention to rel\1rn to my former domicile. and I intend to r~main in
FORT pIEn.CE, iAINT LUCIE COUNTY, FLORIDA,
o' \"' '..-:;'ct-~..,'... <;.
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'. .~. ,\...... 11th
'~ .~t~~~~,~icribed before mE: this
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;I7i;;lI, C:UIT _~T . Not;;;;"'bli"
3y ~ _ D,C, My Comml~ion <,",ire.
[To be exoclited 1n ciupllcat~ Imd ortrln:ll rued with Clerk Circuit court, and duplicate with Tax AssCS30rl
p<rm~<r.t1y1!:ts
. '/~.// -/ ~?1.f~
[Name]
~ S. Romer
GrnycA
[Address]
:lay of
March
19_ 63,
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