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To the Stote ond County Tax Assessor, 234~4
~7 J .J~A~R~+N COUNTY, FLORIDA
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This is my Dectoration of Domitile and Citizenship in the Stote of Ftorida thoi ( am filin~' ' ~
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this doy in eccordance, and in conformity with Section 222.17, Florida Statutes, os amended by
Chapter 26396, Lows of 1951.
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I wos formerly a legal re dent of ~?`t{ • ~~i~ '1~~'~ '
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and I resided at ~ ~'it'l1~~<d~ tt
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St?eet ond Number So~d Ciy ond Stote
However, 1 have changed my Domi i!e to an am and hove b~en Q bono fide resident of the Stote
of Flori in
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da s ce day of - Y
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ond I reside ot ~~t ~L 2 ltlt f~ ~ C z~ tc. !
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St.eet N urv ~ ' co~.nt,
County, ~lorida, ond this siatement is {O l~ f ~~y t__:__ ~ ` . ~ ~ `
~e token as m Decaoroti6n o Ci izens p, actuol
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residence ond domiciie in the State of Florida. (1 nsert here ony pertinent facts, such as sete of
properly o? business or relinquishment of employment at former domicile, removol of fomily to
new domicile, purchase of home, etc.)
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I Further Certify that I will register at my local address when the registration books reapen,
and comply w+th al! other requirements of o legol res;dent of this Stote.
I Further Cef#ify that I have no intention to return to my former domicife, and I.intend to
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remain in __!_~`2~ ~ _ l4r_,~~c,c,---------------------- ~ - ~~_c-c_...~ _ s
Gtr County
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Florida, permanently. 1 ,1 „ i
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fILfO ANO RECOROEO ~
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ST. LUCiE COUNTY FLA. ~ . _ t~=
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ROCER POtUtAS t~ ---------------------------~~------L-
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RECOR6 VER f EO COUAT T~~ A IV ~C ~~C Y~4 ~me~>` Husbond
Jix. t8 2 i2PN'ZI
Nome - Wife ~
234254
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Swom to and subscribed before me this ~~f__ doy WAR VETERANS - ALL WARS ~
of - ~j~-~'' Please Check '
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