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De~laratio~ ot OomiCile and Citlsenship
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~ 122465
TO THE STATE AND COUNTY TAX ASSESSOR~ '
ST. IUCtE COUNTY, FlORiOA:
This is my declaration of Domicile and Citi:enship in ths Stat~ of Florida that 1 am filin~ this day in aooordanos and
in aonformity with Chapter 222, Ssctio~ 22Z.17, Florida Statutea. ~
I was formerly a le~sl resident of ~k~ Qit~ _ tler~id~
(City) (St~t~)
snd 1 resided st O~~ti reme~ber . MowwK t have chs~psd my,domWl~ .
(3treet and Numb~r) ! ' ;
ro and am and have b~en a bo~a fide resident of the Staro of Florida sinoe ' day of ;
nnlcne~.a , 19~, a~ i~~ 1109 8orth 8~nd 3treet
(StreM and Numbs~)
I~ORT NERCE, SAtNT LUCIE COUNTY, FLORIDA~
•~nd this statement i: to be taken as my declaration of c~ti~n~ip, actusl Isgal resid~nos and domidle in ths Sta» of Horid~.
pnsert here any pertine~t facts, such as sale of property or business, w ml •ishment of ~mploy~nent
st fwmer domidle, removal of family to new domicile, purchase -of home c.)
122465
Appl~ing !or honeatead FlL AND R
ECORDED
, ~j•~ .M.li.
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. y~°.`' Y'~~`~o?,~ 1964 Jk~l 20 PH 12. ~8
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. : ROGER POITRaS, CL
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~ y_ - ST. LUCIE COUNTY, FLQRIDA
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' 1 RJRTHER CERTIFY that I will register at my local address whsn ths rc~istration books reopen, snd aomply with
all other requirements of a le~d resident of this State. '
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1 fURTHER CERTIFY that I have no intention to rMum b my f~mer domiCjle, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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ame)
J.C. ~tt Jr.
- . . (Address) ~
Sw~orn to and wbsail : b~for~ ms this ~~h day of 'T~~a~ - 19 ~
RZ...:.-~..-..
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OGER rOiTRAS _s.v0~.`j\~J 11~Y''•.`• ~ ~
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_ C COtIRT ~ ' ' i 1~lotan/ pyb~i~? = '
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D.C. My Ea~rr~ttlprt expiie~
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~J ~~~'1~ I~VE
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Q~ b~ ~xscvt~d {e duplieah and ~iyinal Nl~d wilb CiKk Ci~rit Carri;'and• dnpliab wNh T~oc Ats~aera .
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