HomeMy WebLinkAbout1873_ _ _ __ --
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~Q~~ 27 ~-473-
Disciarotior~To~ Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
StaLucie COUNTY. FIORIQAa
This it my declaratwn of Domicile and Citizenship in the State of Florida that 1 am filing this day in sccordanoe and
in conformity with Chapter 222, Section 222.17, Florida Ststutes.
1 was formerly a legal resldeM of_______---C].Ya~laad- ~-------.-~-. -------. ---~ ~ »)----------
and 1 resided at _-__ __~3--~i11dSY74~T@--~YrT.~@~'r__________ ____ __. However, I have changed my domicile
tSKeM end plumber) - -
t~ to and am and have been a bona fide resident of the State of Florida since .. _ _ - _ _ _ _ _ ZQ~ _ _ _ _ _ _ _ _ _ _ _ _ _ _. day of
-----_-_-- - -QCtG~IeY'-----------------------, 19_~_, and I reside at _~~k-YStt~ R4$ds------------
lStreet end Nurtiber)
------------ ---F~ea~1e~'Cea_ F~Ol'i~-------- ---------------------------------- County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Invert here any pertinent facts, such as Nkt of property a bw:neu, a relinquishment of employment at forms domicil.,
removal of family to new do,nicile, purchase of bane, etcJ
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f IL AND RECORDED
Ih~c~~-GOOK
i5sz~ari is anti: ~s
ROGER P017RAS, CLERK
St. IUCIE COUNTr, FLORID ~~
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
Ft.Pierce,
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Sworn to ahd subscribed before me this - _
StaLuCi@ County, Florida,
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Mil ed y
1104_York Road,Ft.Pie>ec~, _F].4#ida _
(Addreu)
16th . day of _tT anuaity _
ROGER POITRAS _ - _ _ -- _ _ _ - _- _
ROGER POIT AS, CLERK CIRCUIT COURT Notary Public
By _ _ _ _ 0.C. My Commission expires _
~ 9 62
(Te fN e>uKMed ie~ Jrr~licete ad eri~iwet fYed witA Clerk Cineif Ceert, and Je~liceN wish Ta: Asaeseer)
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