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. . Deciaratlan of Ciomi~ite and Ctt6z~nship
Tt~ 1'H~ STATE AND COUNTY 1"AX ASSESSOR, -i-~~-~-~~'
ST. IUCIE C~UNTY, FIORIDA: .
:
This is my declarat(on of Domicila and Ctiizenship in the State of Fiorlde ihat ! am f11ing ihis day in atmrdance and '
in conformiy with Chapter 222, SSecction 2~2.17~ Florida Stetutes.
I w~s forme~ly a legal resident of BOw rlOUrtt Penx~.
(Cityj (Stafo)
' snd t resided.et R D # 1 , Haw+evar I hava ch~nged my dom(c~le
' . (Street and Number)
~ to and ~m end have been a bona fide resident of the State of Florida since 24th day of
~ November 64 Oleande
, 19 , and ! resida at ~ 3b06
~ (Streefi and Number)
' .
fORT MEltCE, SAINT LUCIE COUNTY, ~I.ORIDA
{
~ and this statement is to be taken as my dectaration of ctNaenshtp, actual lega! residerxe and domlcile in the Stat~ of Horids.
. (lnsert hore any partlnent facts, such as sale of property or business, or rel(~quishment of employment
at former domicile, removai of family to rew domicNe, purchase of homa, etc.)
~ ~ntering 4 childsed in the Blementary school
~ : ~ ~stablishing residency
. .
~ - . 1.3~.12~ . . . . . t ~
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pe p = a f: ~c - ~~z~~ ~ ~ ;
~ . ECOR ED ~ : ' ~ _ '
~ AN . : . ~
. - ~hc~ai Record OOK . . U .
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1964 DEC - i AM !0. 31 ~ ~ ~
. - . . '''~,,;,t' c a
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ROGER P4lTRAS. CIERK
~ - ST. lUCfE .CDUMtY, FLO I~
,
s~ , • :
~ f FURTIi~R CHtTIFY thet I will comply wlth a!I olher raqulromsnts af a lepa! reitdent of this Sfate. . ~
. . .
~ I FURTHER CERTIFY that 1 have no intention to roturn to my forme~ domi~ife, and 1 intand to remaln In FOR'i
~'i PIERCE ~ce1~1T lUCIE COUNTY, fIORIDA, pe?manently. ~
• - ,~~t f~ *~1'ti/r~~i
~ . ~ ~ ~i .
r , C? , ~ •
~ -
' ,
. ~ .
't i~ S~ i ~ • f (Namer) ~ ~ . . - .
~ ~ r.~~ ~ Charles Dippre .
=:Y ,~i .
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f . . -
.H ~:l~;~~.;.or~ f ~
At/+~-~"r'
~ r ~ ' (~?cldress)
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Sworn to and subsc~lbed bef~re me this ~St ~~,y af ~~~mDer 19 64
. . : . . -
ROGER rCITRAS ~ ~ ~
. CIRCUIT URt Natary Pubik _ .
~~.s~.c.~ ZG~ ' . ~
` ~Y D.C. My Comm~ssion expires
- . ~ 60Ric ~a~ A .
F C,~~t~~
(1'o b~ uacut~ 1~ dupliuh and orl~~+a! Hl~d wilh Cl~rk prwit Couet, ar+d dupli~h wil1~ Tan As~o~a .