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-a: ..r .+.w D~aluatlon ot Domicil~ a~d CItlsMShip ~ T~O TIiE STATE ANO COtINTY TAX ASSESSOR, ' 1331~l: ST. WCIE OOUt~TY. RORIW4 ~ Thh b my d~dantbn of Oomidl~ and qtit~nship in th~ St~t~ of Horida that 1 am fili~p lhis day tn ~ooordano~ ~nd in oonformity with Chap/K 2?':. s.cr~o~, zzz.~r, r~~da sfatuaa. ~ . ~ w,s form:r~r .~.~aa~ rosid.nt of Peato~ • ~ Mi~souri (Gty) , (s~~t~) . • . ~ ~nd 1 ~atid~d at Rt 2 Box 411 A ~„y~~ • (Str~M and Numb~?) b and ~m and haw b~ • bona fid~ ~id~nt of th~ Stab of Norida sina 7th day of , ~ Februu~ 65 3235 So Fe~esai 8i~ray . 19 , a~d 1 ruid~ at , (ShMf a~d Numb~r) ~ , lO~~ sAMIT LtiClt C011N1Y, RORIDA and this st~t~rwnt ia ro!» tak~n as my ded~ntion of dti~nship, aNu~l Ipal ~~td~na ~nd domkiit in th~ ShN of HoMd~. pn:srt hen an~r pertinsnt facts. :uch u tale of property or buuness, a ~sitnqut:hnlsnt of ~mpioyn~int at formsr domidls, removal of family to nsw domicile, purcha~ of homs, Nc.) , j ' ~ Bateri~g Yeith Aiia~,.~a~~e i• the 2~~ grade • ; ~ . ~ ' ~ . BOOK - . . a,~~ : . . : . _ ~ . ; ~ ' , - 9• - ~ , = - = 42 ~ S AM _ . f, • : _ 19~5 FE8 • : ~ ' ~ ~ . ~ ROGER POITRAS. C~ERK = ~ . • : y' . . $T. LUCIE COUNTr. FLIRI9~ =~-i ~ ~ ~ ,wnr.s : • - - ' ~ S ~ I ~i~~,lJ ~I ~ ~ . ~lv ~ n ~ ~ - . ~ - . ~ aJ~ c~ltTlFlr ~r ~ wll~ oompl~? wNh o~t~ r.q~,inm.M~ of . tp~l n.w«a of 1N. sa~N. ~ ' 1 FURTHER CERTlFlf that 1 h~w n~ iMentw~n to retum to my form~r domidl~, a~d I int~nd 1o r«nain in FOfCT PIERCE. SAINT LUCIE COUMY, fLORIDA, permanentty. ~ ! ~ , . . ~ ~ j , : . ~ f ~ ~ Vl~ tar~ ar~~ ~ :.r ; ? •'v . ` ~~r~ . ~ ~~i~~ ~ C ~ • ' . '''•rI•,~H„~t+`".nd ,ub.vib.d b.fon n+. thi. ~ 8th Februar~ 1¢. 6S ~ . ~ !00lR ~OnRA: ~ ~ ~ CRCtIR COIRT Notary Publk ~ ~ ~ _ D~C. MI? ConrN~ ~xpins . . R~ w~eo~aM~ M~NcM~ a~i ~~i ~i w~ CMrt GiwM C~y aM ~Nsa» wM~ Tioc Arw~a ~ ~ ~ . ~ ~p~~ ~.ZO ~ 32~