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i Dealaration ot Domicit• and Citizenship ~ ' ~
! - . ~ . . 12'~'J`71
' TO THE STATE AND COUNTY TAX ASSESSOR. ~ ~
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ST. IUCIE COUNTY, FLORIDA: . ~ _
~ This i: my d~cla~ation of Domicil~ and Citizenship in ths Stan of Flaid~ that 1~m fflinq this day In aooordana and
. in conformNy with ChaptK 2ZZ. S~ctbn 42Z.17, Horid~ Statut~s.
1 was formsriy a Ipal ~estdent of Il 1~n~ w `
. - ~~~y~ (Statt) ~
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a~d ~ ns~d.d .t 508 west Conoord F+ow.wr ~ haw ch.~psd my dan+w~
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- b a~d am and haw b~sn a bona fide msident of the Stats of Florida sinoe ~y ~ .
~ ~y~ ~ 208 8• 41et Street
- 19 64 , and 1 roiids at
(Street and Number) _
fORT l~CE, S~AINT LUClE COUNTY, RORIDA
and tfiis statemsnt is to be taken a: my dedaration of dtiz~nship, aNusl Ipal ~esidenos and domidle in the Stafe of Horida.
qnsert here any pertinent facts, wch a: ~le of propsry or b~niness, a retinquishmsnt of ~mploym~nt ~
at former domidls, romovai of famity to ~ew domkils, purchase of twme, stc.) ~
8atering deunee Be]~au in 12th t~raae ~ '
~ Fdward BeYsu ia lOth arade
. M Dals 8slcau in 8th arade -1~+"~~'1 ~ ~
N Betty Ann in 5th Grade f~.ED I~ND RECORDED
~ - 800K _
~ 1966 QUG 9: 01 ~ . .
_ ~ ROGER POITRAS. f~ERK _
S . lBCIE COUNTr. fl,OR!
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i 1 FURTHER CERTIFY that I will •
- ~ sll othsr roquirements of e legai resident of this State. ~
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' ~ I FURTHER CERTIFY that i have no inte~tion to mtum to my fwmer dorpidis, a~d 1 intend to rem~in tn FORT
~ ~ PIERCE, SAINT LUCIE COUNTY, FLORI~A, permanently -
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~~aF., ~q at+~l''wbsuibsd b~for~ rr~ ifiis -~th day of ~uanet 19~~-
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i ROOER ~OITRA: "
` ~ Cpt1RT ~ ~ Notary Publk
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~ tTi b~ ~oaaq~d iw d~plicM~ awi ~i~iw~i f~d wilb C1wic qraiM Ca~, ~I a .
~ ~ . ~ . PIfGET~l~~ •
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