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Decla~allon ot ~o~nicil• and Cittsenship p
. 133Q62
TO THE STATE ANO COUNTY TAX ASSESSOR, '
ST. IUCIE GOUNTY, FlOR1~A:
This is my declaration of Oomkile and Citir~n:hip in th~ St~t~ of Florlda that 1~m filinp this day in aooordana ~nd
in oonformity with Chapter 222, Settioh 222.17, Florida Stalutes.
1 wet formerly a legal reside~t of Brookiyn - New Ynr]~
(Gty) (Stat~)
and 1 ~esided et 2824 W 2?th Street Howevsr 1 h~w cfian~sd my domkile
~ (Street atid Number)
b and am end have been a bona fide residsnt of the~St~te of Ftartda sinos 12th day of
~ ' Jsenuary 64
, 19 , and 1 mside at 104 Naran ia Av~. _ Pert St,y~~~; a
(Street u~d Numbsr)
I~ORT ~IERCE, SAINT tUCIE COUNTY, RORIQA - ,
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snd this statement is to be taken as my decla~atbn of dti:,enship, actuat le~ai residsnos e~d domklls in the Stats of Florid~. ~
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(fnse~t here any pe~iinent facts, such as sale ot ~apsry w business, w relinqui~mer?t cf employma~t
at former domicile, removat of femily to r~ew domicile, purchase of horr~e, etc.) .
Applying fox homestead - „
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1965 FE6 -4 PM 2: 57 Z°` • t"r ;
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ROGER POI7RAS. t~ ~ ~~~;b~~,,••`•
St. LUCIE COUNIY. FLIRIDA
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i FURTHER GERTIFY that t wil) comply wlth aii other nquir~m~nb of a~ lepal nsid~nf of thit Stab.
1 FURTHER CERTIFY that I have no intention to ~etum to my former domidle, and 1 iritend to remaU in FORT ~
, PIERCE, SAINT LUGIE COUNTY, FLORIDA, permanently. • ` ~ ~
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. ~ Birnett Bn leman {
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~ 4th Februar 65 ~
`~'Sy~n~ no: a d~ wbscribsd before ms thi~ day of r , 19 .
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ROGER rORRAt '
CIRCUR COURT Notary Publk ~
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(Te b~ uc~hd ~ drpiieai~ a~d aiaiwd t~d wW~ CM~It Ci~a~if Mi d~IkM~ will~ Taa~ A~~~ 't
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