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Declaration of Domicile and Citizenship
TO THE STATE AND ('UUNTY TAX ASSESSOR, r~~~3
St. _Lucie CUUNTY, FLORIDA:
Tl~is is my dcclaration of Domicilr and Cilizenship in the Statc of Florida that 1 am filing this day in
:~rcordancr, and in conl'ormity with Section 2??.17, Florida Statutes.
1 wus fornirrly a leg:?1 resid~nt of --For~slu._I,~_-----_ -,-----~3.scons3a-- - and 1
• (CitY) (State)
Route _ #1 _ _ _ 54935 _ ~ . Nowever, 1 have chan ed my domicile to
msided at . _ - - - - - g
(Strrnt a~J IM1Umbrr)
and am and havr l~~rn a bona tidc residrnt of th~ State of Florida since 1At day ot~
November 19 __70 ~ a~~d 1 resid~ at _Rt 2, Box B 17 Yentta`e Out
(Strret and Number)
Ft. Pieroe , Florida T__ St. Luc3,e _ County, Florida,
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_ - ~c~~~~?
:~nd this statement is to be takrn as my declaration of citizenship, actual (egal residence and domicile in the State
of Florida.
(Insrn herr aay prrtinrnt tacts, surh as vlr uf pruperty or busincss, ur relinyuishment of employment at formrr
domicilr, removal o( famih~ to new dnmecile, purchysr uf humr, rtc.)
!1m a career offioer in the II. S. ~rmy and wish to establish
residenoe in the State of Florida.
' FILEO ANO RECORDEO
! ST. LUCIf COUMTY F~A.
~ ROvER POITRAS
~ OLCPK C:kCU1T COURT
RECOF.n .~Ri~~ED
~
~c 21 2 zz PM'73
_ 262(~83
t FURTHER CERTIFY that 1 will r~gistcr at tny loral address when the registration books reopen, and
romply with all other requirements of a le~al resident of this Statr.
1 FURTHER CERTIFI~' that 1 ha~~e no iirtenti~n to return to my formcr domicile, and I intend to remain in
Ft. Pierce St. Lucie
- - - _ _ - County.
Florida, permanently. Q-`~''~ ~ (~ihN~T~
~ . - - ~
~ (Name)
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. : iirs• .i~t • (~.Wd~) 'r tl .
~ ,.•r .2'~ .
Sworn to 1~~ ~E~~
BTd~'e me thi~ 2~ st _ d:iy of
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~ ~ • _ ~~1: ~ A.I). 19 73 -
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.:OrJD .~r~ C~y'~ ~AG~_ as: t SJa -
. ~ ~t
~ y: , ; ° ~ ~ 17
My Commissiar~.d~~ar'~d~finite - - B~OK2 ~~2~75
_ , _
' (To be executrd in duplicatr and unKinal f~led Hith ('lerk ('ircuit Cburt. anJ Juplicale wilh Taa Assessor)
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