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~ Declaratton Oon~l~il~ and Citisenship ;
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TO THE STATE AND COUNTY TAX ASSESSC~R,
ST. llJC1E GOUNTY, FlORIOA: '
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This i: my declantia+ of ~on+icil~ and Citi~~ip in th~ St~t~ of ftorkla that 1~rn ftiin~ thh day in aooord~na and .
in aonformity with CMpter 2~~. S~ctio~ 22Z.17, Florida Statut~s.
1 wa: fotmKlr a Ip~l ~id~nt of TOl~d4 ~bi°
l'ab) tS~at~
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and 1 rosided at S23 3 l~fest Bandcraf t - t~ovwv.r 1 haw cha~q~d nhr domkil• ~
(Strest a~d Number)
ro and am and hiw besn a bona fide nsld~nt of th~ Stats of Florida dr?a 17th ~
N ove~ber 18S Bsti~ ~n~ Port St. Luci~
- 19~a., and I rosid~ N
(Stnsf a~d Numba)
lORT lIERC~, SAINT LUCIE COYNTY, R~ORtDA
and this statement i: to be take~ as my deduation of dti~sn:hip, actual la~ai reiidsnoe and domidl~ tn th~ St~t~ of Horkia.
pn:e?t hsm -any pertlntnt factt. wch a sal~ of propsrty or buti~sss, or rolinquisl~mtr?t af ~nipioynr~+t '
at form~r domkil~, re~r~ov~l of family to n~w domioit~. P~+Kha~ of hoaw, ~tta
Batabiiahiog residence and appi~idg fos boaiestead
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J."~5~~ RpED.
RILEG AND REC
ST. W G~E ~ vERiF E~•
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~R Zy ~ g'48 .
~ '69 ~
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` COUR7
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I FURTHER GHtTIFY thst 1 vvill aomply vvith ali o~Mr nquinrtwMs o~f a lepal ~t o~ this Stab.
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1~ FURTHER` CERTIFY that 1 have no iMention ta rttum to my form~r domkil~, a~d 1 lnt~r~d ta r~main i~ FORT
PI~•SI1l~T LUCIE COUW7Y, FIORl~/1, pumanentlY•
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•~~,~~'~''•^si~~: . . , . .
. . Ciifton Br~o
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• ~;..Swornlto.and wbscrib~d b~for~ m~ this 24tb MatCL 19 6q,
ROGER ~OITRAS
~ CIRGNT COtIRT Notary Publk
a.~.~Cc,L ~ch~~i p,G, N1y Goirrr~is~iun ~cpka
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Q~ w~a~N~ i~ d~k~aN,a~i ~i~Mal Rf~i wi~fi CM~k C'Mai1 Cwet, a~i ~ wMM Tavc Aw~KJ
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