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Declaration ot Domicite ahd Citisenship j~~~i~'
TO 1'HE STATE M1D COUNTY TAX ASSESSOR.
ST. lUC1E COUNTY. Fl4RICA: ~
Thi: i: my declar~tion of Domidit and Citi~ship In ths St~t~ of Horida that 1 am filinq this day i~ aooordana ++d
in cia?formih? with Chapter 222. S~cfion 222.17, Fkxida Statutas.
Q3,rginia
1 was formsrly a leqai resident of '
• (City)
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~ , F{ow~v~ I luvt chaiqed ~nY domidM
' ~~d 1 raided at
~ (St~eet and ~Numbs~)
+ ~ 8tts day of
b~~ ~m ~nd lwve beein ~ bona fide ~ident of the Stat~ of Florlda sina
~ ~ 902 ~nti$uta ~re•
~ I~Iarch , i 4 63 , and ! ~estde ~ at and Nur~r~)
.
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i lORT M~CE. SAINT LUCIE CO~INTY, RORIDA
i and this statement is to bs taker? as my dedarstio~ of dNnsn~ip. actual les,~al residsnos and domidle in the Stab of Horid+i•
' a bu~ne:s, or rolinquishmsnt of ~n+playm~nt
; . pnsen here any ps~tinent fads, such ss ~le of propsrty
: ~t former domkile, removal of famity to new domicile, purchsss of homs, Mc•)
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' Appa,ying !br haaestead .
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' 1964 JAt~ 2 PM 2. 44 ~ . ~~r~ : ~a~ . : _ = ~ ~ .
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~ ~ ROGER P011RAS. pR10A ~ ~i r.3~,,-=
ST. tUCIE COUN;Y. f L _
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i fURTHER t:ER'TIFlf tfist 1 will ~egister at my loul sddrass when eh~ ~eqistratbr+ books teopsn. and aom~lY with
~II other roquirements of a lepal resident of fhis State.
' 1 fURTHER CERTI~If thst 1 have no intention to ratum b rrry format domic3~e, and 1 in
t
e
n
d to renw in in FORT
p~ERCE. SAINT UKIE COUNTY. FlORIDA, permanently.
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~ ~ ~ (Name)
~ i . Ho~tori
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` U~d~ •
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~ ~ 21tth ~ Jauuar~
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~ j .SMIOffl b~f1d iil~tfi~ ~fOf! if1~ f~t ~
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j ROfiER
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(T~ b~ ~c~sn/~d ~ i~ drpqcal~ awa «idMl t~d wi1i~ CM~ic Cirwit Gw~, a~d d~lial~ wiib Tavc /1s~~~ _
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