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Daaluatbn ot O~rniail~ and CitisMSl~ip
TO THE STATE AND COUNTY TAX /~~SSESSOR,
ST. ltJC1E COUNTY. FtORIDA: .
Thit 4 my aeclaration of Oomkil~ and CiNs~p i~ th~ St~» of Horida fMt 1 am AUnp this day in aooordana and
in confotmity with Chaptef 22Z,~ Ssttion 222.17, Horid~ Statut~t.
I was formerly s leqal rosid~nt of Westwood ~S~'~$Y
(qty) ~Sta~ - ~ _
4
and 1 rosided at 38 St . Nicholas . Avertwe ~~w ~~p~ my domk3M
(Strost a~d Number) .
to and am a~d have bse~ a bona fide ~icknt af th~ Stats of HorWs sinas ~Y ~
Deeeiaber tq
57 . and 1 rosids at u001 Ridge Avenue
(5treet and Number) -
I~ORT M~Cl, SAINT LUCIE COUNTY, RORIDA _
and thls statement is to ba taken as my dedaration of atinenship, sctuai ls~sl rosidenos snd domkile in the Stats o# Horida.
pnsert here any peMinent facn, such as ssle of propKty or buainesa, or ~elinquishrnent of employment
~ at iormar domkils, removal of family to nsw domidl~, purchase of hane. ~tc.)
. , _
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- _ pILEO AND RECORD~~L~
sT.RECORD VERNI
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Dti.~~
.
'6T MsR 30 AN t3~'•
y9
154
r.o~c~ ~o~TRAS _
CLERK CIRCUIT COURT
1 FURTHER CER~TIFY that I will rogister at my (ocal addreu wfien ths reyistration books reopen, and aomply wifh
€ afl othsr requiremenis of a laqal reside~t of fhk Stats.
~
~ I FURTHER CER7IFY that 1 hsve no intention to rotum to my former domidie, and i intend b rornain in FORT .
~ PfERCE. SAINT I.UCIE COUNTY, RORIDA, permanently. s~..
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- 11001 R3dge Avenue - Fort P3,eree, Florida
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~ . F' •snd wbsuibsd !»fore me this ' day of , ~q 67
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'RO~ER fO1TRAS - ~
CLiRK CIRCWT COURT arY Publk
g D C. My Commission expiros g
Y
~ (To b~ ~i is dnpNcal~ aad oei~inal f~l wid~ Cl~elc Cira~it Ceu~f, aAd dupNaN wiM~ Tax A~e~J
~i65 ~1352
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