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' Declaration ot Oomictle and Citlzenship 122~~2 ~
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~ TO THE STATE AND COUNTY TAX ASSESSOR,
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ST, IUCIE COUNTY, FIORIDA: ~
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~ This is my declaratio~ of Oomicils a~d Citizenship In the Stats of Florida that 1 am filin~ this day in aooordents and ~
~ in aonfom+ity with Chapter 222, Section 222.17, Flo~ida Statutes. ~
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; 1 was formerly a legsl resident of~~ ~~~n -
: tCity) (Stste) :
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~ snd 1 resided at ~1
~i~OII ~d . Howevsr 1 have chan~ed my domidle
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~ to and am and hsve been a bona fide tesident of the State of Florida since 15th day of
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3 1eIIUer~ ~ 113 Roel A~e
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(Street and Number) _ ~ ;
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; fORT PIERCE, SAINT WCIE COUNTY, RORIDA =
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~ end this statement is to be taken as my declaration of citizenship, actual legal residence and domitile in tfie State of Horida. ~
i (Inse~t here any pe~tinent fads, such as sale of propeHy or business, a relinquishment of employment
i at former domicile, removal of family to new domicile,-purc~ase of home, etc.~ . ~
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~ • Enteri.~g Claudia 3mith in the lOth grade ~
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+ M Tom~ Smith ia the llth grade
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~ i22~42 -
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. . o~ - FiL~ ~ ~.?~D RECO~tDED
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1 'r.~1•i~?V... ~C :1'.. i .11~ihv~_.~'liUl, f .
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~ i "~Y,~ - 1954 J;;~~ 20 Ai~ 9: 47 ~
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R~CE~ POITRAS. Cl~fi~( ~ :
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I FURTHER CERTIFY that I will register at my local sddress when the registration books reopen, and comply with
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all other requirements of a legal rostdent of this State. _
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I FURTHER CERTIFY that I have no intention to rotum to my former domiale, and I intend to remain in FORT _
PIERCE, SAINT LUCIE COUNTIf, FLORIDA, permanently.
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1Parren T.~~
(Addr~ss) ~
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Sworn to and wbsaibsd before ms this 80th ~y of ~TeIIUBt ~ ~ 19 64 .
ROGER rO1TRAS ' - ~ ~
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qRCU1T C ~J~- J~0 . Notary Public
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~ G:~~ ` : My~~.`ommission expires
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-~~,~:9~ r~-' Q.R. ryn ~ -
-•~-..~_e`- R,~:•t I~i Fsr_r7 f1
(fe b~ ~oncvt~d in dvplicah and ~iaai fif«i wif[~"'Cl~elc:i~rcvit Cour~, and dvplica» witl~ Tax Ass~swr.) .