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Declaratton ot Domicile and Citizenship ~
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12~434 ;
~ TO THE STATE AND COUNTY TAX A?;iSES50R,
ST. lUC1E COUNTY, FtOR10A: '
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This i: my daclaration of Oomicile and Giti:enship in the Stats of Florida that 1 am filinq this dey in aao~rdanos and '
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~ in aonformily with Chapter 2Z2. Saction 2Z2.17. Florida Statutes.
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1 was formerly a legal rosident of ~IIaaB Cit~ _ MO t
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(C~y) (State)
~r~ t cssidsd st 9~Q~ ~?4~h Te~raos . Howeva~ ! have char~ed my c~omidle
(Straet and Number)
to and am and have be~Qn a bona fide resident of the State of Florida sinos 1s~ day of _
Catober ~ 83 1912 111~?aming A~s.
, 19 , and 1 reside at
~ (Street and Number)
l~ORT rIQC~, SAINT LUCIE COUNTY, fLORIGA
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: and this statement is to be taken as my deciarstion of citizenship, ectual legal residence and domidle in the Stste of Horida.
(Insert here any pertinent facts, such as sale of property or busines:, or reltnquishment of emplayment
' at former domicile, removal of family M new domicile, purchase of home, etc.)
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' App~ying !or homesteed 12,~434
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~ FI ~~'D RECORDED
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- ~cord~OQK
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: 196~ J~;;~ I E f~~i 10:
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' ''~•~'1~ti'?~ ROGE~~ POITRAS. Cl.~RK ~
:~•.-yJU .i ..'~;t{.•;. S1. IUCIE " o ~
~ . - - .COO~~TY. FL~C~.IDA _
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I FURTHER CERTIFY that 1 will rsgister at my local sddreu when the ~gistration books reopen, and oomply with
ali oThsr roquirements of a le~al resident of this Sfate.
1 I fURTHER CERTIFY that I have no jntention to retum to my former domicjle, and I intend to remsin in FORT :
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PIERCE, SJ11fVT LUCIE COUNTY, FLORIDA, permanently. -
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' Sworn to and wbsaib~d befon nw this 18tih daY 9f ^ JaIILtlll'~ , ~q 64.
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R. ~..~.~.a M~.~..~a .~,~r ~,~,w c~.~.,c~ c~, ~nd dupiiat~ with Tax ~a :
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