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~ - Oeclaration ot Domicile and Citlsenshlp ~
~ ~ 128462
I
TO THE STATE MtD COUNTY TAX ASSESSOR,
. ST. WCIE COUNTY, FLORIDA:
Thi: is my d~cluation of Domicils and CitiZenship in th~ Stats of Fiorid~ that 1 am f11in~ this day tn aooordana a~cl
.
In oonfotmity with Chapter 2Z2, Setfion Z22.17, Flotlda Statutes.
~ wa: former~y a leqe~ rostdet?t of ~ 8loomington . Illinois
. - (CNYI ' (Stats)
208 Meaaows Avenus , ~
a~d 1 rasldsd at • ~ Fipvwver f hav~ chsnqec! my domWl~
(Straet and Numbe~)
! b~nd am and have beer? a bona fide rosident of the Stat~ of Florida sinos 2~ day of
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Augusti . 19 6~ 139 Luoero Drife, Part St. Lucis
, , and i roside at
~ - (Stre~t snd Numbeir)
. FORT rtERC~, SAiNT LUCtE COUNTY, f1.OR~A
snd .thia statemsM i: to be taken a: my dedaration of dti~snship, actval Iagal r~ide~os and domidis tn the Stats of Horidat
, ~ pnsert here any pertinsnt faet:, wd~ a: sale of properry or Ixniness, w miinquishmsnt af employment "
at formsr domkile, mmoval of family to new domkile, purchase ot hoaa, ete.)
~ ~~ttED ~Stp ~ECORDED .
Ee~ablishing reeidenca OQOK ~ , ~
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1454 AUG 24 PM 3: 58 . . .
, : ~L~.`-~1 ROGER P0ITRAS . '
; . ~`-s~~ : t<<, ~ST tUC1E COUNT . (~.ERK
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- . 128462 .
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; t fURTHER CER'TIFY thst 1 wili ~y w~
j all ofher roqui~ements of s leqaf ~ident of this State.
~ ! RIRTHER CERTlFY that 1 Fbve na intention to mtum to my former domidle, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORiDA, permanentiy. •
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Swor~ fo and wbsaibed befor~ rn~ thii 2~ ~,y o~ Avgtlst 1~~
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~ ROG~ rOR~AS
~ CL~NC CNt tT tOURT Notary Publk . .
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C. My Cam?iss{on ~xpit~s _ .
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Ri b~ ~ iw d~ptkaN sed oriaM~l til~d wMb C{~Ic U~ Cow~, aad d~piiaN wilb Tax Ar~or~
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