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132541 ~ D
Declaration ot Do~nlctle ~nd Citisenship
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TQ TME STATE MI~ t~OUNTY TAX /0.SSESSOR, '
Si. WC1E COUNTY, FIORIDA:
Thi: is my declantion of Domicile and Gitizenship in the Stats of Florida thaf 1 am filirp fhit d~y In aooordana a~d ~
in conformity with Chapte~ 22?, Section 222.17, Florida Statutes. ~
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1 wai formerly a legal ~eiidant of NCw Ytlrk Cit~ ' •New York
. (City) ~ ~StN~.)
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~ and I rosided ~t 17 :1' C*4th St. Howsv~r 1 haw chanpsd my domidl~
(Strset ~nd Numbs~)
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b a~d am and havs bes~ • bona flde rssidNnt of the Stats of Florida stnos 4~ d~y of
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~ O~tober . 19 64. n ?46 Altura St. River Park
~ (Stre~t ~nd Nun~ber)
lORT NERCE, ~AINT LUCIE COUNTY, RORIDA '
a~d this statemsnt 1s to be taken as my dsdarstion of dtizen~ip, actual le~al t~sidsnos and domkils in th~ St~t~ of Horidi. '
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(Insert here any pertinent facta, such a~ ssle of property or business, or relinqui:hrnent of ~mpfoym~nt
at form~r dornidle, removal of family to new c~omkile, purc~is~ of ho~r~e, ~t.3 ~
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!N al E~ ~ 132541
. New Domicile 80~K
1965 JAN I 5 QM e~
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_ $ROtUC E COUNRY FLORIDA ~
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~ _ 1 RIRTHER CERTIFlf that I wlll aomply wNh all ofh~~ nquinm~nb of • Ipal r~sW~nt of thi: Stah.
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! FURTHER CFRTlFY that 1 have no intRntion to retum to my former domidle, and I Intend to ramain in FORT
PI UCIE COUNT1f, FLORIOA, permanentty.
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~i,`~~;:vr • • p~.me)
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~ ~ s ~ ~ ~ Vinceat D~vid Gor~le~
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to .nd subscr~bsd befo~. m. ~hk isth ~y ~ Janusrp M tq 6s ~
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CLERIC CtRCtiR c:-u:CRT Notary Publk
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. Sf? D.C. My Carnnission expi~ ~
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(Ti b~ ~aN~d M drpNcal~ a~d ~eiOM~i t~i wi11~ Cl~k CM~rN Gw~, a~i d~aN ~aat ~
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