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Dscla~atlon ot Do?n~iclle and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, 13352`'~' ~
ST. IUCiE GOUNTY, KORtDA: f
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This i: my declsration of Oomicile u+d Citizenship in tl~e St~ts of Ftorida th~t 1 am filinq thls d~y in aooordanca ~nd ;
in aonformity with Chapter 2Z2, Ssction 222,17, Florida Statutes. ~
Detroit Michigan ~
I w~s formerly a leqal ~esident of '
(City) (Stah) . • .
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~nd 1 rosided at 18234 Washbu=a HowevK 1 have chanysd my domWle ~
(Stroet and Number) i
b and am ~nd have been • bona fide rosident of the State of Ftortds stno~ 20 day of ~
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Aprii 64 100 Serenata Court, Port St. Lucie ;
. 19 , and 1 reside et {
. (Strost and Numbsr) ;
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I~ORT MERC~, SAINT LUCIE COUNTY, RORlOA ~ . i
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~nd -this statement is to be taken as my decla~ation•of citiz~nship, actuai leqal residsnce a~d domidle in the State of Hotida. ;
' (Insert hsre any pe?linent facts, such es sale of propery or bu=iness, or mlinquithment of employm~nt ~
at former domictte, removal of family ro new cbmicile, purchase of hor~ne, etc.) '
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Bstablishgin resideace
- 13352'?' ' . ~
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tM eT RECO~pEO - -
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~ i965 fE6 23 flM t0: 29 • ;
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. - ROGER POITR s - 'o ~-:?""~tr ~
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- ST. LUC1E COUNTY, FLQRIQa '
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i FURTHER C~TIFY that ! w!!I oomplY with a!I othsr rputrem~nt~ of • Ipal r~ident of thb State. ~
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1 FURTHER CERTIFY th~t 1 have ~o intention b retum to my formar domic3le, ~nd I intend to remsin in FORT ~
PIERCE~~
f~N~`'~LIJCt~ ~OUNTY, FLORIDA, permanently. ~ . ~
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dress CLrtin
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~ 23 Pebruar 19 65
~ Swom to and wbscrib~d b~fore rra this day of ~
ROG~ r01TRAil-
~K ~ Notary Publk
ef? ~ 0
C. My commluion expir+~
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= f ' BORI( 111 ~AcE ~27