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Declaration ot Domicile a~d Citisenshlp
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ro ~e sT~?~ Mro cauNr~r Tnx ~ss~ssaa. 12'~'~J?;~ `
ST. LUCfE COUWTY, FLOitIDA: ~
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Thk is my decl~ratio~? of Oomkil~ arx! CNiranshlp 1n 1hs St~ts of Florida that I am filin~ this day tn aaoadanoe and {
i~ oonformity with Chapt~r 222, Sectbn 222.17, Ftorid~ Statuta. #
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. 1 was forn~ly a lpal resld~nt of ~nt _ Oh30 ~
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and 1~ided at . HovwvK 1 haw chsnqed my domkJla `
(5tre~t and Numbsr) ~
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. b ud am ~nd hav~s besn a bons fids .rosident of the State oi Florlda slno~ lst day of ~
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~ _ ,DMl . . 19 64snd 1 reside at _ 1013 S. 12t~ etrest
(Street and Numbsr)
~°ORT M~CE. SAINT L!lCIE COUNTY, RORIDA
a~d this :tatement is to be tak~ as my dectantion of dti~snihip, adusl leqal ~atidenos er+d domkile in the State ot~Ho,ride. ~
qnsert here any pertiment facts, wd~ as sale of property or business, or mlinqui~mant of ' Of~'~~J7~
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~t f~ornx~ domidls, rs~rwva! of family to new domkile, purchass of har~e, etc:j : s;t ~ r'
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Entering ohildrend-in soh~ool sad estebliehing reeiden~o~ ,'lt~~r~'
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~hirs~ine Plan~r in lith grade
tsll~as planar ~a gth araa• ~~~_I ECO DED
Oynthis Plansr in_5th arads 8 $QOK
196~ A~1G =3 PM 1: 59
~ ttOGER POITRAS.
~ St. lUC1E COUN~Y. flORl _ -
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1 FURTHER CERTIFY thet I witl oompty with
all othar roquireme~h of a feyal resiclent of this State.
• 1 FURTHER CERTIFY th~t I have no intention to rotum to my former domi~jfe, and i tMend to mmsin in fOR't'
PIERCE.y~ I CIE COUNTY, FLORIDA, permane~tly.
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= Swan b rnd subsu~bd betorf mt fhk . 3~ dsY ~ ~~~t ~ , 19 ~
ROtiER rO1TRAS ~ ' ~ ~
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e!? . D.C. t; My C~nrnission ~xpt~
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