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~~#iort u# mti ' tt~td~ fQ'~ti~ts ' 29~=~80
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To fhe t~ County Tex Assessor, _
1~b~ "~'~.OUNTY. RORIDA
This is my Oeclaration of Domicile and Citizenship in the State of Florida that 1 am filing this dsy in aaoord-
ance, and in conformiy with Sectio~ 222.17, Florida Statutes, as amended by Chapter 26896, laws of 1951.
I was fomnerly a legal resident af.~_____~~~----------------------- -------~~~-~-rk--°
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and i resided at _ 1433 Chili Street _
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However, I have changed my Domidle to a~d am and haye besn a bona fide reside~t of the State of Florida
sinoe _________2~_---~-_-- day of _----_-_-~-4~~.4~~r 19~4, and I reside ai
Outdoor Resorts, ~_Jensen Beach __________~Min ~ouny, Florida, -
ShNt and t~m~ber City
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and this statement is to be taken as my Declarotion of Citizenship, actual legal residence a~d domicile in ihe L-
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State of Florida. (Insert here any pertinent facts, wch as sale of property or business, or relinquishment of ~
employment at former domicile, removal of family to new domicile, purchase of home, etc.)
I have retired from mY~rofession as a dentist and our home. in - ;
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~LD RMP +i R - `
Rc~ hP~t _r~ NPW~IIrk-iS_ OG~~ P~tT~ f~
o«~K c~~cun ~'ou~tt
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' I~Further Certify ihat I wil! register at my local addreu when the registration books reo~en, and oomply
~ with all other requirements of a legal resident of this State. ~
~ 1 Further that 1 have no intention to return to my former domicile, and I intend to. remain in
•1!/aa~ Martin County, Florida, permanently.
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Name - Husband
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~ Name - ~fe
; /.as. wae v~aNS - au waRs
$wosn~t~~ ~ before me this day
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. _ . . Please Chedc
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- ~ . ~~in}ier 1974. O
~ _ + tQ'w~~y' 1 - Spanish American
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y^~~~ - = - 2 - World War i O
~ '(~iaal ta ~ Acknowled ment ~
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~~~2~''~~q.:.~+ 9 9 ~ World War II
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~ ~ - 4 - Korean Conflid ?
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NOY~ P~/~.IC, State d Florida at Larg~. 5- None ?
INY C'ommksion Exdres Aprf1 9, 19]$ •
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ao~z33 ~1573
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