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s i i~ r~nti Cttis~n~t~~ -~.~2~~-~ ~
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TO YWE STATE AND COUNTY TAX ASSESSUR,
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ST, LUCIE C~UNtY, FIORIDA: ~ '
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~ This is my declaration of Domiclle and Citizenship in the State of Floride that I em filing this dey tn aao~dante end ,
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~ tn conformity with Chapter 222, Section 222.17, Ftorida Statutes.
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` Huntington Beach• Cali£oznia `
~ ~ 1 was formerly a legal resident af }
j (Ciry) (State) i
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~ • 2U582 Bgrct ~.ane ~
and 1 ~esided et - . Howevef I have changad my damic~la ;
(Street ~nd Number)
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to and am and have been a lwna flde resident of the State of florida sinte 23 day of
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• Dccember 64. 29U8 Sylvan Terxace ~
~ 1 , 19_~, and ~ reside at
' (Si~eet and Numbe~)
~ FE?RT PtERCE, 5AINT WClE COUNTY, FLARIDA • ~
~ and this statament is ta be taken as my declarotion of citi:enship, actual Ieqal ~esidence and domicile In the Stste of Horida. ~
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} (insert here any pe~sinent facts, such aa sate of property or businass, ar ret(nquishment of employmenf ~
' ' at former domicife, removai of family to new domicile, purchase of home, ett.)
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~ ~ Enterin~ ahaldren in 2~d and 4th Gxadts ~3~-~-~
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~ ~ . FllfD ~ANO RECOR~~O ~
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~ ~ ~ ~ . ~ 1964 DEC 3I A~ Ii: 32 = - . ; .
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~ ' t~.;M' ?,.s ~ . ROGER POlTRAS. CIEf~K - ~ ~
~ rt , • ~ - ST. LUCIE COUNTY, F~R1DA : ~ : ~
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p~ `•~f ''FY ` i~ s
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• ! FURTHER CfRTIFY that I wil) oomply with aii ~ther r~uiremenri of a legai tesident of thi: Stab.
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I FURTHER CERTIFY that t have no intention to return to my former domic~le, and 1 intend to remain in FORT '
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. . , -
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,~~'~o/ • . ~ (Name) ;
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# M i i. i.' , l ~
, :i °:#.t~f. ~ . v eaaa WallACe ~ ~ ? t
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~r - Swam to and subscribed befora rree tfiis 3~' day of DrGember .~~9 - b4.
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~ ~ i ~ ROGER POfTRAS . .
CtERK CU{T COURT Notary Publlc ~
8y D.C. My Commission exptres -
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, (To bs ~x~tut~d tn duptis~h and ori~t~al Hl~d wkh CIK1t Cireu~t Cou*f, and dvFlkatr wi1~t Tau Aswa~.~
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