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~ Oe~laration ot Domlcils and Citisenship 132~3
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TO THE STATE AND COUNTY TAX ASSESSOR, ~ ~
ST. LUCIE COUNTY, ROftIOA: -
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This is my deduatio~ of Oomkile a~d Citim?ship in th~ Stat~ of Horida th~t 1 am ftiinq thit day tn aooordana and
!n oonfamity wlth Chapter 224. Sectlon 22Z.17, Fb?id~ St~tuta. ~ .
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~ i was forn~s~~r a Ip.1 ~w.m of Palm Heach ~ Fl~. -
~ _ ~ (City) . (Sta»)
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, 1~~ Graham Bckes Scbooi Ha~r~v.r 1 haw clNnp.d my domWi.
~ lStroM and Number)
~ b and an and h~w baa~ • bona fide rosid~nt of ths Stat~ of Flaida ~ina - September ~y ~
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~ ,~q 40, ~ n P.O.Bo~c 805 Tensen ec _ ~ia~
' t5tr.~t ~nd NumbK)
lORT M~CE, ~AMIT IUCfE COUNTY, RORIDA -
j a~d this~tatsnwnt is to be tske~ as my deduation of dti~snship, ~ctud Ipa1 r~sids~o~ a~d domkil~ in th~ Sht~ of Hortda: .
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~ pnsert her4 any pertinsnt facts, such as s~te of properry or buslnsu, or mNnqulshn~nt'~~ ~mpbym~nt
{ ~ ~t farmat domkils, rsmoval of family to new domidls, puahase of harie, N~ ~
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~ Appiying for homestead .
132333 -
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~ fll AND RECORDED ~ -,~""~„N..,.....,,, .
BOOIC ~ .
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. 1965 JAN -1 PM 1: I 2 ~ - ~ N~:
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ROGER POITRAS. CtERK . u _f-~ • ~ .
s 7•.~~:~,~~,
ST. LUCIE COtiN1Y, fLOR1DA ' ~
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} I RJRTHER C~tnFY tfwt 1 wiil compty with ~ii othu rpulnm~nh of . Ipal n~J~J~nt of M~b Stat~. -
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~ 1 FURTHER CERTIFY that 1 have no intention to rotum to
~ mY former domWl~, a~d 1 i~t~nd to tPrr~ain 1n FORT
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t, PIERC~ SJ11WT U1CIE COUNTY, FLORIDA, permansntly. ~
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G'p~ s M~~I
~ = j-~~~,~~~ ~ : » ? Welis Hively
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Swom to and wbx~ibsd bsfor. this 7th January , t~~
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~ ROGER ~OI'RAs
Notuy Pubik
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df? 0 C. My Gommissfon ~cpin~
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~ R~ b~ ~whd is d~plkat~ a~d ~rtoM~l AMd C~w~, and
d~ wi~M Ta~c A~~a
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