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+ oeclarAtion ot oomic~l• and Cittzenship 1-28518 ~
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TO THE STATE /WO COUNTY TAX ASSESSOR, .
, S?. tUC1E COUNTY, FIORIDA:
Thi: is my dedaration of Oomicils ~~d Citis~nship i~ ths Sfate of flortda fhat 1 am fiUnq this day in aaoord~nos and
in aonformity with CMpter 22~, Sectlon 222.17, Florida St~tutes.
- ~ was forn»rly a Is~a1 ~Went of - CHVRQS HILL _ _ . - TffiJ8 _ _
: , tCity) , l'Stab)
, and 1 ~uWed st Routs 5 ' 1
. Howwvs?1 haw chanQed my domWls
~ (5treet irx! Number)
' b and am a~d haw been ~ bo~s fids ~tdent of the Stst~ of Fbrida ~nos 28Lh . day of
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~ ± ' M~et '
~ j ~ 19 6;~.~ ~~~ds ~ 336 Barroalough
. (St~eet ~nd NurnbK)
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• I°ORT MERCE. SAINT LtIC1E COUNTY~ ROR~A ~
, and this statemsnt is b 6e taken as my dedsration of dti~sn~ip, actual lepal ~~idenos and domkils in ths Stah af HoNda.
~ qrasrt here any pertinsnt facts, iuch ~:ale of property or busineu, or ~elinquishmsnt of emptaymsnt
i at former don+kile, romoval of family to new domicile, purchase of tw~r~e, etc.)
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3 Ehtering Donnis doe Adame in ths 3rd grade
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Jtid~ J1~dsms in the 9th grads
~ " alenda Adams in l.he lith grade
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~ " Ce~rol~a Adame in the ilth grade . .
~ ~ _ ~~851 . . - .
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s~, ~ ~ • ~`t r ~GU • .
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1 ~lci. ~~v ~t''~~LY. • '
~ . l-. ~ w. 1964 ~
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~ ;-...M~; i ~ AM 10. 32 ,
R06ER
, .t . POlTRAS. C[ERK
~r F ti° . ST. !lICIE COUNt~. ftORtO
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~ 1 FURTHER CdtTIFY tlNt 1 wiil with ail other itar~a~t= of a ~
~ . ~Y ~q~+ I~pa~ nsW~nt of this Stat~.
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. ~ FURTHER CERTlFY that.l have ra inte~tlon to ~etum ta my formar domicile, and i intend to romatn tn FORT
PIERCE, SAINT lUC1E COUNTY, FLORIDA, permanently. . :
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~~r?f~ ~worn,~, ~~~4bsaibed b.for~ m. this 26th ~ Au6u
• ~+Y 19~
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ROO~R ~OItR/1f
~ ~K . Notary PuWk
~ ~ws.iCc.~. Z~Ik.~~L~ •
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My Corr~niuion ~xpi?~s
. ~ . ~ . ~ ~pRx 97 n?~14~: ;
R• b. .ao.ar~.~i iw d~ile.~. .wa .~i~a! til~d wMM a~eic a~ri1 c.wf, .na dYpaa~: wbM t,oc As~:~.era
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