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~ DeclAration ot Dorniails and Citisenship ,
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TO THE STATE ANO COtJNTY TAX ASSESSOR, . ~
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ST. ttKiE GOUNTY. flORIGA:
This is n~y deduation of Danicil~ and Citiu~=hip i~ th~ StaN of Florida lhat I am illirq tfils day in aooordanq a~d
tn conformily with ChaptK 2Z'l, Settbn ~?Z.17. Florids Statute=.
i was formaly ~ teqal rosident of Columbus • ~ Ohio
(CitY) ~StaN)
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' and ~ ~.sid~d ~t S18S Maplerid~e Drive , Howw~ ~ h,r, d„np~d,t,y don,Wl~
(SNeet and Number)
, b and an~ a~d haw bs~n a bon~ fide ~esident of the Stata of Ftorida sinw 1St ~y ~
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- ~ June ~q 64 ~ ai . 106 Na=aA3s Avenue
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Port St. Lucie ~ I~e1•t ~"d Nu""b~?)
' ~r nHecE, sr?n~ wc~ couNr~r, aoRro~ ~ -
and this statemsnt it to bs f~ken as my decluafion of cittzemhip, ~ctual lepal ~Kid~nos and domidl~ tn th~ Stat~ of Hodd~. -
pn:srt hsrs any pertinent facts, such a= sale of propsry or bu:lnas, or rolinquith~nYo~ ~mploytn~f
at formK domidle, ~smoval of famity ro new danicile, purch~ss of home, Mc.)
_ • 132349. . .
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; . . IN Fl ,A RecoOtd~
, ___~___BDOK .
i~ 1965 JAN -7 PM 3: 05 : o . .
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_ ROGER POtTRAS, CtERK . .,t. ~-.~••ti~ .
Batsblisbign residence S1. LUCIE COIINtY, ftORiDA •:•w' '~'~r, i
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' i FURTHER CERtTlFY fhat ! wIq comp~ly with aii o~1F~sr nquinRr~nb of a Ipil t~tid~nt of thb Shta.
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~ ~ 1 FURTHER CHtTiFY that t have no. intantion ro mtum ro my domiyls, ~rd I imend~to r~maM in FORT
PIERCE~.SAINT ~LLJCIE CWNTY, F~ORIDA, permenenfly.
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~ :'~~?;!ti.~ . , v Kellison T. Condon
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sw~o.n ro•nd wbscrib~d b~f«. m. thb ? day of January y tq 6S_
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; ROGER rO1TRAS -
~ i CIRCU COtlRT Notiry Parbik
bfl ~ - D.C. My Cornrntasion ~xpt~
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0. R: ~OO FACE~ Gf ~H5 ~
tto b. .o~.w~.a Iw d~ppcsM .ea «foi~.i Bl.a whb a~ek cMa~ car~, ar,a aYpik.~. wid~ Taoc A~..~.K,~
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