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Oecla~atio~ ot DoMicile and Citisenship
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TO THE STATE AND COUNTY TAX ASSESSOR. 1
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Sl, lUC1E ~OUNTY, FIORlDA: ~
This is my dacia~ation of Oomicile and Citizenship in the Sta?e of Ftorida that 1~m filinp this day in eooordence and ;
in aonformity with ~hapte~ 222, Section 222.17, Florida Statutes. ,
1 wa: formerly a leys! ~esident of .~_~41~1'~_.~~S.p~Ct Ill_
(Ciy) (State)
206 North wille ~
•nd 1 resided at ~ . However t have chan~ed my domiClie
(Street snd Number) ~
to and am and have been s bone fide resident of the State of Florida sincs 18th day of
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llec embe r 64
~ , 19 and 1 mside at _,.113 ~3each ~~ve_ kive Park
~treet and Number) ~
I~Q1tT MERCE, SAlNT LtlCIE COUN?Y, RORIDA
and this statement is to be taken as my daclaretion of citizenship, actua! legal residence end domicile in tFw Stsro of Florida. ;
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(Insert here any pertinent fatts, such as sale of property or busineu, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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Applyin~ for homestead ~
~_32'754 ~
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1965 J~i~ 25 Aii 10: 20
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ROGER POITRAS, Ct~Rit - ~ ~
ST. LUClE CGJ!''s'~. Fii:~~:~" - . . _
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I RJRTHER CHt?IFY tfi~t I will aomply with all other requiremsnts of • le~al residsnt of this State. ~
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1 FURTFfER CERTIFY thet 1 hsve no intention to return to my former domicjle, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently,
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G`
: ` O (Na
: ` _ ~ ; ' G~ ' Alfred U. piees (Sbiers ~
~ ' ' • r •~,l+. r ~ I . , r •
_ t ` : ~ Jeanne ~ress)ypiers
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l~,•l ~ Swd~rr to ~nd wbsuib~d before ms this 25th day of 3anaury 19 65
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CtRCU~T COURT Notary Publk
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dY D.C. My Commiuion expiras
Re b~ ~anevhd 1u ~eM~ ~d Ki~iw~l Hf~d wi1i~ q~ric Ciearit Cow1, and dupliata wHb Taoe A~ora ~
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