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Oecla~ation ot Oo~nicile and Citlzenship -1-62"~~ ~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORlOA:
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This i: my detlaration of Uomicile and Citizenship in ihe Stats of Florida that 1 am filing this day in aooorda~ce a~d ~
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in conformily with Chapter 222, Section 222.17, Florida Statutes.
1 was formarly a legal ~es~dant of Chippaqua New York _
~C;y~ (Stero)
7 Marshal l LaAe Flov„ever I have cha m dom~tile
and 1 resided at ^ y ~
(Street and Number)
17th ds of #
to and am and have been a bona fide resident of the State of Florida since Y #
_ Novee~ber , ~q
67, e~ ~ res~de a~ 2853 Morningside Blvd, Port St _ L-ucie ~
(Street and Number) ~
FORT PlERCE, SAINT LUCIE COUNTY, RORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legal residente and domitile in the State of Horida. ,
(Insert here any pertine~t facts, such as sals of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchsse of home, etc.)
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Bstablishing residence ~ - - - - ~
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FILEO AND RECORDED'~
ST. LUCIE COUNTY. FLA. ~
RFCORD VERIFIEO
162250
'6T DEC I PM 3: S
t~e~~R ~O~TRAS ~
CLERK CIRCUIT COURT
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1 FURTHER CERTIFY that I will oomply with all other requirements of a leqal resident of this Stbte. ;
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I FURTHER CERTIFY that I have no intention to retum to my former domiG~e, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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. ~ " v ~-'_t/
~ ~~~i (Na~)
~ J ~ ~.z'i~ .
^ ~ Archibald G. Gates
_ . v. ~
- ti • i.? _
- . • ~t ~ (Address)
_ • •fi~ .
. L/:'~v,~n.~ s`nd sut~scribed before me this lst day of Decewber ~q 67 =
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ROGER rO1TRAS ~
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CIRCUIT URT Notary Public ;
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gy ~.C. My Commission expi~es . #
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(To b~ ~ncuNd in duplicah and ari~inal Rl~d wi~h CIKIc Circuit Court, and dupl~cat~ witb Tax As~or.) .
6GOK169 PAGE1.1.~7