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Oeelaratio~ ot Oo~niClte and Chtsenshlp ~
10 THE ST11TE ANO COUNTIf TAX ASSESSOR, 132514
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ThI• ii my dacluetion of Oomiale a~+d Citit~+sM?ip in th~ Sut~ of Hor?c3a M+at I am fil~~q M+a da~r a~ooordai+a and
in conformity with Chapta ?22, Sestion 22~.17. Florida S~stvtsa.
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I was formsrly a leysl ~esident of Tu Ily ToMrn Penn
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' a,d ~ ~~ded,t 21 Stone~ Brook Drive , ~K ~ ti~~,~ ~
~Stt..t and Nu+rnbai)
` b and am and haw been a bona fids ~ident of the St~ta of Flaida sina 16 th diy d
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~ July , 19 64, i~~ ~ SSS Airosa Blvd. Port St.Lucie
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1°ORT MERCE, SAtNT WCIE COUNTY, KORIGA ~ ~ .
and thii statemet?t is to bs taken as my dedaratwn of atinnship, actwl Ipa! reaid~na?and domicit~ in th~ Srst~ of fiorida. ~
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pnssrt here any pertinsnt fac~s, sucfi u sale of property or business, or r~linq~'rstirwint of srnp~o~nn~r»
at former domicile, removal of family to naw domKile, purchasa of F~o~ne, e~c.y
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Bstablishing residenc~
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~ 1965 J~N ! 4 AM 10: 26
~~G~~'--'~ ROGER POITRAS. QERK
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~ c,~~•~~:~~ l~~ St. IuC~E C~ufttr, F~GR~DA
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I FURTHER C~TIFY M1it I WIII OOfT1PI~/ W~TI1 aII OIfNf' fA~1~f~ftlMlb O'f ~~i~ f~Kl~fit 0~ Mi~i Sfi1~.
. I FURTHER CERTIFY that I havs no iMention b ret~,m to my formar domqla. arxi 1 ir~snd to r~~ -M FQRT
PIERCf. SAlNT LIIClE COUNTY, fLORIDA, permanentiy. ~ 1
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G~ j F ~C-• Louise P. Bzusb~
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