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~ Declaratio~ ot Domicile and Cltizenship
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. ~ ST. LUC1E tOUNTY, FLORIDA: ;
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~ , This is my declaration of Oomicile and Citizen:hip in the State of Florida that 1 am filin~ this dsy in acoordsnos and ~
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in oonfo~mity with Chapter 222, Settion 222.17, Flo?ida Stahites. ~
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~ I was formerly a leyal ~esident of Edieoa _ Ner Jereey
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# 21 Ea~tlioY Road
and I resided at . However i have changed my domicile s~_
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~ ro and am end have been a bo~e fide resident of the Stats of Florida sincs ~'9~ day of i:
' 901 ~itrna ~~e. '
~ aoIIU~1 , 19 and I roside at -i
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~ FORT PIERCE, S/UNT LUCIE COUNTY, RORIDA . • ~
and this statement is to be taken as my declaration of atizenship, actual legat res~dencs and domicile in the Staro of Fb~ida.
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~ (lnsart hera any pe~tinent facts, such as sala of prcperty or business, or relinquishrr:ent of employmen! `
~ at fomne~ domkile, removal of family to new domicile, purchase of home, etc.) - r
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~$ntering Panl Tooabeon in the 2nd grede '
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~ ~ ~ura an~ai ~nton in the 4th grade 1~4~5
" ~herlotte in the ~th grade
~ • ~hrieti~n sa the 6th grede FltEO Ai10 PECORDED
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;v~;; 1954 JfN 20 PN 4: 55
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o. . _ ROGER POITRAS. Clz~K
; r;r s~ _ ST. IUCiE COUNTY. FLORIDA
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1 RJRTHER CERTIFY that 1 will rogistet at my locai address when the rogistration books reopen, and o~mply with
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all other requirements of a legal resident of this State. ~
I FURTHER ~ERTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. '
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(Name)
I.enra F aaaobaoa
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(Addres:)
S~worn to and wbsaibsd before me this 80th day of JBIItiitl7 ~ ~q 64 . i
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GRCUR OtJRT - : :c~ ~:=•~Nota~y Publk
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6~/ D.C. . aM~ Comniissidri ~xpires
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(Te b~ ~onevhd in duplkah and ori~ieul Rl~d whb Ckrk qrsvh.!Lartl,'.s~d duplica» with Tax Ass~ssora ~~1
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