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Deciaratton ot Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR. 1491.~~3
Sl. lUC1E COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I arn filing this day in accordance and
in conformiy with Chapter 222, Section 222.17, Florida Statutes.
_ Missiouri _
I was formerly a legal resider~t of . _ $41 - _ - _ _
• (City) (Stab)
and I resided at 1~Q$.__ O~k St~__ _ . However 1 havc changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since lOt h_,_ day of
Oct 66 63~5 North 2nd street ( Anglers Lodge
_ 19--_-, a~d I reside at
(Street and Number)
FORT PIHtCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Florida.
(lnsert here any pertinent facts, such as sale of property or business, or reli~quishment of employment
at former.d'omicile, removal of family to new domicile, purthase of home, etc.)
Entering rrank 6uker in 8th grade
FILEO AND RECORDEO .
ST.R
UC ~ RD VER~~
'66 OCT I 2 AM ~ ~7
149138
~ {~O~~Ft r01TRAS _
CLERK CIRCUIT COURT
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1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domi~ile, and I intend to remain in FORT i
PIERCE, SAINT.~,IiCIE COUNTY, FLORIDA, permanently. ~
• ~ ~
, - _ J~ E%7'I~.ma,a ~=w~erL
} : ' : (Name) ~
~ " Th~mas Cuker ( brother)
. : ~
'
~ (Address)
' ~ ~ .
Sworn to and subscribed before me this 12 day of ~Ct• ~ 19 66 ~
!
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ROGER POITRAS -
K CIRCUIT OURT Notary Public
G-c~~ ~G~,~,e,~c.G~
By D.C. My Commission expires
(To be ~xecuted in duplicate snd original filad with Clerk Grwit Cou~f, and dupliut~ wiN~ Tsx Assessor.)
BOOK 1~ PACE SOt~
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