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D~cl~~atio~ ot Domicile and Citls~nship 1~~8 :
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TO THE STATE ANO COUNTY TAX I?SSESSOR, ~ ,
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Sl. UJCIE COUNTY. FLORIDl1: ~
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This ii my decl~ration of Oomicile ~~d Citizenship in the State of Horid~ that 1 am fili~q fhis day in aooordana a~d
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in ao~formlty with Chapt~r 422. Ssction Z2Z.17, Florida Statutes. ,
+ P1Qrida
I was formerly a leqal ~~sidsnt of ! Bronson
(City) (Sf~bl
and I resided at p•O.Box 98 Gulf 1lammoCk Fla. ~ 1~~ ~rpsc! my domidl~ '
(Stteet and Number) ' :
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ro and am and luve been a bona fid~ msident of the Stab of Florida si~ 23Yd day of
` October ~ 1964 , a~ ar ~402 Solan KoAd
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fO~T MERC~, SAINT LNC~ COUNTY. RORIDA .
and this ststement is to be taken as my declaration of citizenship, actu~i lepal residenos and domkile in the Stat~ of Horida.
p~sen here any pertinsnt facts, such ss sale of property or bu:ines:, or rolinqui:ha+ent of ~mploymsnt
at former domidls, removal of family to new domicile, purchsse of home, etc.)
. 133a81'
A~plying for homestead flj,~ AN ECOR ED .
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_ __,__._BOOK
~ ~ l965 FEB -5 AM 10: 53 .
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~ ; _ -~'s?~: - ROGER POITRAS,
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' , ST. LUCIE COUNtY, FlO~RIDA
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; 1 fURTHER CERTIFY tl~at I wlll oomply with sll other requintn~ntt o~ a{~p~i nsld~nt of this StaM.
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f I~F4RTHER, CERTIFY th~t 1 have no i~tention to retum to my former domk3le, and I intend to remain in FORT f
~ PIERCEy3AINT.WCIE COUNTY, FLORIDA, permanently.
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Sw~orn to and wbsorib.d b.for• m. thts Sth ~y Pebruar~? , 19.~~ . i
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C~CUITpp~q~ ~ Notuy Publk • ~
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C. . . Mr C+ortwniuion axpi~
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