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oectaration ot ~omict~e and Citt:enshlp f' 133591
TO THE STATE AND COUNTY TAX ASSESSOR, •
Si. IIJCIE COUNTY.. FLORIDA: . ~ ~
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This i• my declaration of Oomicile and Citizenship in ths State of Florida th~t 1~m filinq this day In iooord~no~ and i~
ln oonformiy with Chapter ~72. Ssction 222.17, Florida Statutes. ~ j~
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1 wss formerly ~a taqal ~esident of ~v~r Dtl• = i
(Ciw) (Stah) ~
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•nd 1 rosidsd at 105 Old No zth kpad my ~w~~ f~
(Street and Numbsr) - ~ ; ~
ro~nd am a~d havs baen a bona fide re~ident of the StaM of Florida sinas ls t day of
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llec , ~q 64 a~ ~ reside at ~58 Ashley Street
(Street and Numbs?) ~
fORT MERCE, SAlNT LUClE COUNTY. RORIOA -
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and this statsmsnt is to bs taken ss my declaration of citizenship, actual legsi residence snd domidle in fhe Staro of Horida. ~
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(Insert hers any pertinent facts, such as sale of prope?ty or business, w relinquishmsnt of employmsnt ~
at former domicile, removal of family to ~ew domicile, purchsss of home, etc.) ~
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~st~blishin~ res~ctency j
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133591 ~
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G~ ~T ~o f ILED A~D RECORDED
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' d;~~~• ~ a~: 1965 FE8 25 AM 9: 43
= ' = ROGER POI7RAS. CIERK
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' : - : St. IUCIE COONIY. fLORIDA
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t RIRTHER CERTIFY that 1 will oomply witfi al! otber requtrerr~nti of e Ispal r~sldsnf of fhb Strt~.
1 FURTHER CERTIFl( thst I have no intention to ~etum to my former domicjte, and 1 intend to ~emain •n FORT
PIERCE, SAINT LUCIE COUNTY. FLORIDA, permanently.
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Swom to end wbscribsd bsfor~ me fhis 25th ~y of Feb. ~`19 65
OG~ ~ORRAS _
ciRCUrt couRT Notary Pubik
°"''~`'e' D.C. My Canmiuio~ ~xpins
R~ b~ ~a~arbd iw d~plic~h aed «i~ind Al~d whb CIKk Cina~it Cewt, swd d~p~Na1~ wNlt Tax A~r,~ -
~ du~~ i1~~. r~cE 5~ 0
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