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Deci~rution of Domicile and Cittsenship ~ +
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TO THE STATE AN~ COUNTY TAX ASSESSOR~
• _ Sl. lUCIE COUNTY, FIORIDA: ~ ~
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Thts is my declsration of Domicila end Citi~enship In the Stats of F!o?ida thst i am fllinq this day Irt aooordanos ~nd
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in oonformity with Chapter 222, Section 222.17, ~lorida Statutes. ~
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I was forme~ly e leqal resident of _ ~
(Ciy) ero)
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and i msided at O~~.~L .r,.~•~ Howev~ 1 have chanqsd my clomidta
(Shaat and Numbsr) ~
~ I to and arn and have baen a bona fide rosidant of the Staro af Fiorida sinos '-~~a~ day of ;
19~ and I reside at ~~s~• _ ~i..~
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l~ORT MERCE, S~AINT IUCI~ COUNTY, RORIDA . .
and thts ~statement i: to be taken as my declaration of dtizenship, aduai I~gai residenae a~d domfdle ir~ the Staro b~f Florida.
(Insert here any ps?t1neM facts, such es sale ot property or bu:iness, or mlinquishmsnt of emplaymenf
at fomne~ domicits, removal of family ro new dorr~idle, purchase of home, etc.)
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FllEO AHD RECORDED - ~ .
!N ' 800K
1964 AUG 18 pM 10: 41 _
~s ~ ~ c ROGER POlTRAS. CIERK ~
~'~~St. IUCI COU T'I. f LOR10 A - .
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l~i ~';'F~ I~~JRTHER CERTIFY thst I wtll ~P~ ~
all other requirements of a legai resident of this State. -
. I FURTHER CERTIFY that I have ~o intention to retum to my former domi~ile, and i intend to ~emain in FOItT
PIERCE, SJ11NT LUCIE COUNTIf, FI.ORIDA, permanently.
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;:;~v ~ j.~ier,~ to and wbsuibsd before me thit da vf
! y 19~
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; CLERK'~IRCUR COURT Notsry Pubik
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~ ~ ~ a ~.G. My Commisslon ~xpira
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_ ; Ro b~ uaeut~d ie duplieat~ and ori~n~l fil~d whh quk Qrsuh Courf, and ddplicah ~ao~
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