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Declaratlon ot Domicii~ ~nd Citisenship ~
TO THE STATE AND COUNTY TAX ASSESSOR, ~ 13 c j
ST. WCtE COUNTY, FtOR10A:
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This is my decl~ratiw~ of ~omicile ~nd Citi~nship i~ th~ Stu~ of Florlda that 1 am fillnQ thls day in ~ooordana a~d
in oonformity with Chapter 4Z2, Ssction ~4~.17, Florid~ Statuta.
1 wat formsrty a teqai ~~idant of Peekskill • New York
(City) ~ (Sta»)
935 Phoenix A~re. , ~ ~
and 1 rostded at Ho~w~vK I h~w thanysd my domklt~
(Stresf ~nd Numbe~~
to ~nd am a~d havs been s bona fide roside~t of ths'St~te of .Florlda tinct 21 day of
~ ~ ' April '
, t9 64 , a~d ~ rostds at _ 8t 2 Box 3264 Lakewood Pk
(StrMt and Number)
~ I~ORT M~tCE. SAINT LtK1E COUNTY, RORIOA ~ - • ~
and this staten~t i: to bs taken as my declaration of citizen~ip, aclual lpat ~tttdenos ~nd domkile in the Stat~ of HoNda.
(Inse?t hsre any pertinent f~ct:, such as ~le of propernr or business, or ~eltnquishn~t of ~mplo~ynwnt '
at former domidls, removai of family to new domicils, purcba;s of horr~s, etc.)
Establishing residency and applying for homestead ~
1329~5 -
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~ ~ FlLED AND RECORDED~ ~
Ih..~uiali
B~e~-800K ~ . .
- ~ 1965 FEB - I AM 10: t 2 o~
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. ROGER POITRAS. CIE~KK ' ' ~ ~ w
~ St. IUCIE COUNTY. f 18R10A • ~ - . _ ~ : ° ~ ~ ' ' , ;
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1 HlRTHER CHtTIFY that 1 will oomply wfth ali ottMr nqv of • i~p~l n~id~M of this Stat~.
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_ i FURTHER CERTIFY that f have no (ntentlon to retu ta my former domkjl~, ar~d 1 lntend to rematn in FORT
- PIERC~,.SAINT LUCIE GOUNTY, f.LORIDA, pertnanenNy. '
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~ Gv\S CO ~4
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t•°~~ V 1~ ti'~ i ~cG~ ; . .
F.;. ; ~ Harold A Stoae ~
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ss t.• ' - 1?~asion A Stone ;
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to'ir~d wbaaib.d b.for. m. ~his issa ~y ~ Februar~ . ~
19 65 i
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~ ~ rorra?s ~ ~ ~
CIRCUIT COURT . . Notary PuWk
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o.c. -Mr co~~o~,
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< <Te b~ .~w1.d h~ dupiicaN a~ «~ioMal Al~d MrNM Clwk GrnN C~~ ~1 ~Ilew w11b Tioa Ai«~J
~ • ~ 1~0 F~ 42 , = .