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~ Declaration ot Oomictle and Citisenship ~ i
' 1224`72
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TO THE STATE AND GOUNTY TAX ASSESSOR.
~ ST: IUCIE COUNTY, FLORIDI~:
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i This is my daclsratio~ of O~icile and Citizenship i~ ~ S~ate of Florida that I am filinq this day in aaoord~no~ and
i in oa+formity with Chaptsr ~?4. Ssction 222.17, Florida Statv~es. .
i
} l~orth Cenw~ l~ew 8anpahirs
' 1 was formerly a Ipal resident of _
~ (Ciy) l5tate)
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' Dinamore Ro~d
, and 1 rosided at t~lowever i have d~nged my domidl~
~ (Streef and Numberj
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~ ro end am and have been a bons fids resident of the Stet~ of florida sinoe day of
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t ~1''°h ~ ~707 3u 15th SLreeti
~ , 19 , and I reside at
{ (Stroet and Numbsr) . :
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~ fORT ~I~CE, SAINT LUCIE COUNTY, RORI~A . • ; • C ? ~
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} and this statement is to be taken as my declaration of dHzenship, actual legal residenos and domidle in the Sta~e qf Fl~ida: . Q:
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qnsert hsro any pertinent facts, s u c h as sa le o
f property or b
us iness, or re l inqu i s hment o
f em ' me~~ •.y~~
, ~ : ~ • r.
Z at former domkile, romovai of family to new domicile, purchase of twrr~e, etc.) = a:•
4 •i ~t '
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• ~I~N •
~ ~ ~pplying ror hoaestead ~
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+ - _ .:1 T... .
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A,~;~~~p~ l~ECO
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~ y, . `r • ^ - • - 1964 J~i~ 2
= r ~ ; ' • : ~ PN 2: 07
E~ ,`f j''-~v. , ~ SR~
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F ~OI~RAS. Ctf K
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I FURTHER CERTIFY that t will rogiatsr at my local add~ess when ths registration books reopen, a~d aomply with
all other requi~ements of a legal resident of this State.
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~ 1 FURTHER CERTIFY that i have no intention to rotum to my former domic3le, and I tntend to remain in FORT
~ PIERCE, SAINT LUCIE COUMY, FLORIDA, permanently. ~
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F llvia /~a~~pode]c'd
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Sworn to a~d wbsuibed before me this 80th ,y ~ J'a~ai"y 19 6~r
ROGER rOiTRAS ~
Ct~RK CIRCUR COURT Notary Public
b~l ~ ~~~1~ D.C. My Commisslon expires
~a~RK . ?9 PecE227.
~t~ b~ ~oawNd ie dvplicaN and e~i~inal Ai~d with Cl~k Graiit C~ourt, and dupliaN witb Tax As~siora ~
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