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' O~cla~atlon ot oo~nici~~ and Citisenship 13~15 ~ ~
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TO TFIE STATE MI~ COUNTY TAX ASSESSOR. '
ST. IUCI~ COUNTY. FIORIDA: .
This is my dsclaration af Domicile e~d Citis~nihip i~ th~ Stafi of Florida that 1 am filinq this day In ~ooordar~o~ ~nd
in conformity with Chap»? 2ZZ, Ssction 222.17, Florid~ SfatutK. ~
I was form.~ly a ~eqal rostdent of Stuart • Fl,orida
(City) (Stah)
~nd ! nsid~d at - p.O.Bo~t 443 ~ lrl~chigu~ Avenus,,, , H~~ ~~w cha~?qsd my domidN `
. (Stre~t ~nd Numb~~) ~
b Md am and haw be~n • bona fid~ ~id~t pf the Stat~ of Florida ~inoe 13 daY of ~
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. Februar~ 65 Route 4 Box 194 ,
, , 19 , and 1 rosid~ at ~
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l~ORt ~ sA1NT Ll1p! COUNTY, ROR~A
and this statemsnt is ro bs taken as my dadaration of citim~ship, actual Ipal resWenos and domidle in.th~ Stat~ of HorWa.
qnssrt hero any pe~tinent fac~s, such u~le of propsrty or buainess, or rolinquishment.of ~mpioym~nt i
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at former domiclle, removal of famity to new domicile, purchase of home, ~tc.) .
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Flt,ED AND RECOROEO ~
~ ' BOOK
Bsteriag so• ia 8th Grade .
$ateri~g daughter is bth Grs~e 1965FEB t5 AM 9:52
- ROGER POITRAS, ClptK
St. LUCIE COUNTY, FLIRIDA -
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I FURTi~IOt CHtTtfY Mwt t wlil_ oompiy wNl~ dl ofF~ nqu~ of a Ipai raW~nt of thls ~Sfit~., f
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t FURTHER CERTIFY th~t 1 have no intention to return b my former domWle, snd t inte~d to remsin in FORT '
PlERCE, SIUM. LUCIE COUNTY, FLORIDA, permansntly. ;
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• (Nams) :
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``r ~ ~ • 1, Itrs. Sa~ie Vandiford '
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. S,w~orn a~+d wbsai!»d b.for~ m~ thb ls ~y ~ Pebruar~ , 19.,~~
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ROOlR ~ ~OITRA:
. , Notary Publk - . ;
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d~/ D.C. My Gonwnisslon ~cpt~ ;
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j ~T• b~ ~oawl+i M d~Nca1~ a~i ~eioMil AMi wilf~ C'I~k CMa~i1 Gwt, a~ d~NeaM whl~ Tax A~r~ ~
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