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Oeclaration ot Oomicll~ a~d Citt:~nship ~
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TO TIE STATE /1N0 00lJNTY TAX ~155E5SOR, .
51. UJCIE COUNTY. FlOR10A:
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Tht~ is my~deda~atlon of Domkil~ and Citi~nship 1~ th~ Stat~ of florida th~t 1 un fi{inq fhis day M~ooordina and
i~ oonformHy with Chapter ~4?, S~ction 222.17. Horfd~ StatuMt. ~
1 wu form.?ly • I.~a1 resldent of B~nt " L. I. New York
. ~ (City) (St~rN
~f 231 Miriam Parkway ~w~~,~,y~~yM ~
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b and am a~d h~w bNn , bon, ftd~ nsW~nt of the St~t~ of Florida tlnos 4th _ d~y of
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September , ~964 n ~610~ Pr~a ces Av~nue
(StnM and Numb~~)
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a~d this statat~t is to be taken as my dederatfon of citlzenship, actual lepal ~aidena a~d domidl~ in tM Stat~ of HoNda.
p~ssrt here any pertins~t facK, such as ~ale of prop~erty or business, or ~ellnquishna~nt`~ ~mploym~nt
~t former domidls, removal of family to nsw domidk, purchase of homs, etc.) .
Applying for homestead eaemption i
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(j b~~_tr - : ~ ~ AND RECORDnED -
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l965 JAN 18 AM 10: 34
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~ ~ ROGER POITRAS. CLEIIKK
''~•~••~~»M~• ~ St. LUCIE ~NTY, f ORIDA ' . - ~
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1 FURTHER GERTIFY that 1 will aomply with ali other nquir~rrwnh.of • ~pi1 r~id~M of thb Syt~. j
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. ! fURTHER CERTIFY thst 1 have no lntsntbn to retum to my formsr domidl~, and 1 intrnd to ~in in FORT ;
%ERCE, SAINT U1CIE COUNTY, FtORtDA, perma~?entiy. ~
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_ ~ , ' _ subscrib~d b~for~ m. thi~ 18t1~ ~y Januarl? ~q 65 ~
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