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~C~~~OA Of ~011~~~i a11d rr~i~li~1~1 -
TO THE STATE ANO COUNTY TAX ASSE~SOR,
51. ~UCIE COUNTY. FLORIDA:
Thh is m~r dsd~ration of Oomicil~ and Citiurnhip in th~ aia» of FlorWa that 1 am filinq lhis day i~ aaoo?~dano~ a~?d
in aonfwmlty with ChapNi 222. Setfion 2ZZ.17. Rorida StafuN=.
~ w~ ~~r ~ ~~t ~ St. Joaeph Miasouri
cc~~y) l~+ta
and 1 nstd~d at 300Z /ingelique 1~~~
~ (Stnet snd NumbK)
ro~nd am and have been a bo~s flds nsid~nt of th~ Sta» of Horida sino~ Sept . 29
~ (port St. Lucie)
, 19_b.B_, and I ros1d~ at 3330 Mont+ Yista S't~P_At
' ~}fAlt ifld N11~MI~f~
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VY~.. ~ ~A ~ .
and this sbtMr~t is to be taken as my dedaration of atizenship, actuai le~al resideno~ and domicile in tha State of Horid~.
pns~t here a~y pertins~t facts, such as sale of property or business, or relinquishm~nt of emplaynwnt
~t ~mK domkil~, rorrwval of famlly to nsw domiate, purcha~ of home, e1c.)
Piacing child in school
. FlIED ANO REC~RDED' _ -
ST. LUCIE COUN YEOIA•
_ R E1C~~
~ Y '68 OCT 1~ bM 8:~ S O
R4GER ~OITRAS .
CLERK CIRCUI? COURT
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i RJRTHER CgtTiFlf that" 1 wili aoa+ply with sll atl~ nqutnm~nts of a Ipal raid~M o# thb Stata. E
~ I RIRTHHt CERTIFY that i have ra inte~tion b roturn to r»y former domitile, and I inrond to romain in FORT
~ QIf~tCE. SAINT LUCIE COUNTY, fIORIDA, permanenMy. • ~
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~ ' ttl`i: 7i;t~ ~ t H~' w~Vr~~~. Br~~n
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. SiMOrti t;o;~id~wb~vib.d brtor~ n+. d~is ~ ~y OCtober ~q 68 .
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CI~ C~C1NT OOtIRT No~ary PuWk
8~r - D.C. M~? f~n+rrds~ion ucpina
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