HomeMy WebLinkAbout1957 . r. . ti : ~ : .p• e•v q/.. y --si !b: " ` ti !'.~:1:~' r .
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D~claratlo~ ot Domicll• and Citis~nihlp
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TO THE STATE ANO COiUNTY TAX ASSESSOR, '
ST. lUC1E DOUNIY. fIORIDA: :
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This is my d~daration of Domicite and Citlzs~+ship in tfi~ Stat~ of Florida that i~m fitlrq thi: d~y in aooondano~ ud ~
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in oonformity with ChaptK 22Z. Section Z22.17, Hortda Stahita. ~
~ w.s t~m.,~y , ~e~.~ ro~went of Beckle~ ~ West Virain ia :
(Cityl (Stat~) . •
Staaford Rozi ~ '
and 1 n~idsd ~t . . Howewr 1 h~w chanqsd mr domWl~
(Strest and Number)
b a~d am and haw bMn a bo~a ftd~ residsnt of the Stat~ of Flo?ida slno~ 12 ~y ~
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Pebruar~ , 19 65~ N tY#3 Sailfisb Batates ;
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lORT S~ANrT L~IC~ COUNTY, RORIDA
and this statemsnt is to bs taken as my dsdawtion of citizenship, actu~l iipal ~esideno~ and domidt~ in th~ Sht~ of Horida.
pnsert here any pertinent tacfs, wd~ as sale of property or businsss, or mllnquiihmsnt'of emplo~yn~t :
at formar domklls, mmovai of family to new domicile, purchase of ho~ne, ~tc.) '
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Batering son in 3rd Grade ~ ..~~~~"~"~`''`~~•,f
" daughter in lst Grade -;='•~~l. .
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1333'75 ~ ~ N . ~
E pN RECOR r~= " ~ ; '
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1965 FEB 16 ~M 1. 3~ . ,
' ROGER POITRAS. CtERK :
. ~ $1. LUCIE CQ~NtY. fIORIbA ;
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t FURTi#R ~6RTIFY th~t t wlll avmply whh aN otFNr r~quir~r~nls of • Ipd rM~d~nt oi 1hb Stat~. 4
~ RIRTHER CERTIFY that 1 have n~ lntention to retum to my former domidlf, and I infend to rerrwin in FORT
PI9tGE,~ SAINT. LUGE ~OUNTY, FLORIDA, psrmensntly.
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~ Sw~om q-i~ wb~utb.d b.ton n+. Nas 16 d,y Pebrusr ~ 19 65
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C. .~1~I ConwMuion pcpi~u
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R• IM ~oaew~ M d~eM~ a~ ~etrM~i AIMi wli Cl~k Cf~~aN ~wwr, a~i d~Nea~s wMi~ Tix Aw~~~
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