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To the State and County Tcx As.sessor, ~
ST•~ COUNTY, FLOIRDA: j
This is my Decloration of Dornicile and Citizenship in the Stote of Florida that I om filing
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this day in accordance, and in conformity with Settion 222.17, Florido Statutes, Qs omended by
Chopter 26896, Laws of 1951.
ttigh Bridge, heR Jersey
1 wos formerly a legol resident of
c~n~ s~on
ond I resided ot __131 Cre~sr_Raad~_High_Brid~e2_he~_Jerse~r •
sr?»t «,e r~,~++e.. so~a c~a «,a star.
However, 1 hove changed my Domicile to ond am ond hove been a bona fide resident of the Stote
of Florida since 6th ~y af __I'ebrusr~__________ ~ 1969
and I reside ot _60? Ho~ard Creek Ln.L_~P_0_Stuart~;______St~ Lp~~e______ _
st...r «,d ~+e« a~v c«W,ti
County, Florido, and this siatement is to be taken as my Declarotion of Citizenship, actuol legol
residence and domicile in the Stoie of Florida. (I nsert here cny pertinent focts, such as sale of ~
property or business, or relinquishment of employment ot former domicile, removal of family to
new domicile, purchose of home, etc.)
_ High Brid~ez N.J. _home_aold_Jul~y_1969._Kente3_home_at RT_2~ St._ Lucie
Dri~e fram Feb__ 69_to Dec_69i__Rented home at_?04_Gardenis A~e.~__ ,
_ Ft._ Pie~~e~_~t9~ Ds~ Sis_th~u_~iay__'ZQ._~laYS~intn .ne~_hiune_~_fi0?_--- ~
~ _ ~4~~d_~r.~_Ln~_un...Z,~ttLni~lta~r_19~__i~Bea~Si~sga~ub~.i~iai~n_
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- - Sa~pZo~ad-b~ Sa~i#.son--Do~i~ss -I~o,.-~~~t11-ind~a~~osa-~-Jn.p~torr -BI a.
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~ I Further Certify that I will register at my tocol address when the registration books reopen,
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5 cnd comply with all other requirements of o legal resident of this State_ .
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~ I Further Certify thot I have no intention to return to my former domicile, and I intend to ;
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~ r atabove addreRa in Kesu Birsge Stnart (P. U.) St Lucie ~
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City Ca~r+ty ~
~ Flor~o~ Rer~r?R~ntly. 1[ARTIN T. GOTTSCHAI.$
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' ff~EO ~NO aECpRpEp ~ - - ~ - ~
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~ iT. WCtE COUMTY FIA. Name - Husbond ~
' IIOCER ?OITIIA~
~ CIERK CIRCUIT
RECORO YERIFIED i~~~ -
~ N~u 30 9 ~s AM ~ Name - Wife
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Sworn to and subscribed before me this doy ;
h ; wAR v~a - nu wu~s
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Y o--- 19~-~L• j Pi~a~ Ch~ck
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1 - Spenish American
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ota~'~uslitlq,q otFur Officiol taking Ac ledgment ;
• t 2- World War I_ '
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`p~res ~ 3 - World War II- _ - - ?
- • 9h1~c, Stde oi Florida at LuW
- i o• ~LQr.1~Y Flo id
i s; ' mission Expires lune 21, 1914
~ 4 - Korean Conflict~ _ _ _ . ~
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