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• Ferar E. T. c.soi.v-t~oY-~-io.as~ 14853'7
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Declarotion of Domicile and Ci#izenship ~
TO THE STATE AND COUNTY TAR ~i?SST.SSOR,
St. Lncie ~pUNTy~ FI,pRIDA:
T6is is my declaration of Domicile and Cltizenship in the State o~ Florid~ tLat I am fllin~ this d~?y in
accordance, and in conformity with Chapter 2r2, Section 222.17, Florida Statutee.
I wss formerly a legal reaident ol.~Do~er `«a, ~ Da].a~~~a)
snd I s~esided at.~~. Ho~vever, I have c.~an~ed my domicile
($trest and Number) _
to and am and have been a bona flde resident oi the State of Florida aince, ~~L_~.~ _dsy of ~
~ _ , 19 and I reside at_]~QW~ oi~ Blvd (P.3L) :
(8trest and Namb~r)
Fort Pierce ~ 3t. Lucie Connt~?, Florlda,
, tcxb)
and this statement is to be taken ae my declaration of citizenship, actual legal residence and domicile in
the State of Florida
(Inssrt Lers ao~ pertinent iacts, such ss sale oi soperty or bnaina~s, or r~linqniahmeat of emylo~ment at
ao
io:mer damieila r.mo.al oi ismih to nrw doani e. Pnrchsse od hom~. st~.)
~ILCD AND REC~~
8~. WCIE COtlNTY ~ '
, . RECORO VERIFI~O
-'66 SEP t 9 AN 8: 37
ROGER i~D17R '8 .
CL~K CIRCUtT COURT' ~
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E Addraaa reP~1=
~t.~?• s. x.~~~xs
p~~s,rta~rrt oi state
F93 - I~JAI~DA
~taahington 25, D.C. ~5~ -
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I FU~iTHEA CFdtTIFY that I will regiater at my local addresa when the regiatration booka reopw, ~
and comply with all other requirement8 of a legal resident of this 3tate.
1
I FIIftTIiER CEBTIFY that I have no intention to return to my form domicile, and I intend to remain
in_ Fort Pierce , -~L~-- _County, orida,
(Clty) -
PermsnentlY• '
S e s
• (Name)
- ~ Ameriaan Coneulats Gen
i•~:~~~'~L';,f~~~'~ ~ ~ ~ - ~
Swo~r t~ ~nd sul'S~ri~d before me this~l'L_daY of
~b~.:~~ti • ~ °la , A. D. 19 ~ .
j=~ Tdya~; .k~ A~i±~;c+uk ~ice Consul
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`~YY~af •'-T- , •
M3? ~om~s.io~ ~p~~ '
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(~1'6 •~e ~tied. in doPlieate aud ori~in~l Skd w~tb Q erk Cireait Comt. aad dopUeate witL 1"az As~es~os)
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