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~ Decl~ration of Domicll~ anci Citizenshf~ ~
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TO THE STATE AND COUNTY TAX ASSESSOR, ~
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i ST, lUC1E COUNTY, ~L4RIDA: ~
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~ This is my declaration of Domicile and Citizenahip in the State of Ftortda that 1 em f~ling thtt day in erco~dance and ~
in eonformiry with Chapte~ 222, Seetion 222,1~, Florida Statutes. ~
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~ I was formerly a legal resident of B4st Brunwsick N~_-T_ ers~v
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o (Ciry) (5tete)
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~ • 35 Windsor Drive ,
t and t ros(ded at . Howevar I hava ehangcd my damidla~ :
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~ to ~nd am and have been a bona fide re:ident of the State of Flarida since ~ day of ;
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~ ' J~ua'~y ~5 1821 Kaufman 1~venue - ~ ~
~ - , 19 , and I reside at ;
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~ FORT PIERCF, SAINT LUCIE COUNTY, FtOR1DA - • ~ ~
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a~d this sta!ement is to be iaken as my declarotion of citizenship, aciual tegal r~sidence and domtcile in the State of Florlda. i
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; . (Insert here any pertinent facts, such as sale of property or business, or relinquishment of employmant
at form iomicile, removal of family to new dsmicile, purchase of hame, etc.)
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: $ntering children in 4th, 6tta and lOth Grades t.~ l.~.` ~ ~
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/ D RECORD~D ~ ~ t ; n ~ ~ ~
FILED AN
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3 1965 JAf~ -4 AM l I: 56 ~
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. . ROGER POlTRAS. CIEftK ;
, ' ST. LUCtE C0Ut11Y, FIORIDA ~ ~
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; - 1 FURTNER CERTiFY that 1 tvHt camply with aN other requirem~nts of a lo~a) resident of this State.
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~ - 1 FURTHER CERTIFY that 1 have no intention to return to my former domi~ile, and 1 intend to. remain in FORT ;
~ FIERCE, SAINT LUCIE C4UNTY, F10RIDA, perrr~anently. _ - {
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. _ ~ ~ ~ - • • (Namaj
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~ ~ - Josephine Areur3 ~
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~Sworfr"~o and subscribed before me thJs ~ day of J~ y , ~ 9~,
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R0~3ER POITitAS - '
tERK CI IT COURT Notary Public
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. $Y D.~. My Cammiasion expires ~
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Ra b~ ~x~cut~d in dupiicah a~d originsl fll~d with deric Clnuit Cour?, and duptiuM with Tsx A»ea~er, •
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