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Oecia~atlo~ ot Do~icll~ and Cltlsenship ;
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~ .133398 ;
TO THE STATE M1C COUNTY TAX ASSESSOR~
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Sl, tUCtE GOUNTY. FIORIDA: ~
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Thi= is my d~clsration of Oomicile a~d Gitizenthip in ths State of Florida that 1~m filinQ thi~ day 1~ aooordana and ~
in cor~famit~r with ~hapter 222, Section 222.17, Florida Statutes.
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i was formeriy a lagal resident of Ind_ ~
~ (City) ;Stah) ~
Rt . ~ 1 , ~
ard t nsided at . How~ver I have dwiqed my domWte
.(Street and Number) ~
~ to ind am and have bsen a bo~a fide residsnt of the Staro of florids sinos lst day of ~ i
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' Au~ust ~ 19 64 a~ ~ reside st 1612 So 30th
(Stroet and Number)
I~ORT ~IERCE. SAfNT LNCIE COUNTY, RORIDA _
and this statement is to be taken as my declaration of citizenship, actual legal residenrs a~d domkile fn the State of Horida. +
(Inserr here any pertinent facts, such as sale of (prope?y a business, or relinquid+ment bf emplo~yn~+t f
at .former domicile, removal of family to new domicile, purchass of hane, stc.) ~ ~
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Esrt$blishing residenay and applying for homestezd
. - 133398 - ~ -
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~I~~ANp ECORQ~D ~ . : ~ , ~ :
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1965 FEB ! l PM 2: 3 I i:~
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ROGER POITRAS. CIERK `.r'.~••., ~ .
ST. LUCIE COUt~TY, FLORIOA~-i 1~
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1 RJRTHER CHtT(FY that I wii) oomply witfi all othsr roquir~nts of •!pd rosident of this Stat~.
1 FURTHER CERTIFY that I have no intention b retum to my former domkils, and 1 intend to remstn in FORT .
PIERCE~~~Tr~~UClE COUNTIf, FLORIDA, permanently. -
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~l G~ 1 COG
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_ • ;
, . ' - ; Kenneth ~iea~tham
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~.'N 'r
'~V (/4ddrou~
~ G~ ~ ~ Marlene Cheatham
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Sworn b~nd wbscribed before ms fhis 17 ~h ~r of ~ February , 19 6S
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CpURT Notary Publk :
°`"-~`'e D.C. My Commisslo~ axpins
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