HomeMy WebLinkAbout0204 . _ . .
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~ ~ Oeciaratlon ot Domictle and Cftize~shlp ~~;s~
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~ TO THE STATE AND COUNTY TAX A~Sp550R, ~
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f ST. lUC1E GOUNTY, FIORIDA: ~ 1~54
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j This is my decl~ration of Oomicile and Citis~nship in the Stat~ of Florld~ that I am fili~p this day in aooord~nos a~d
~ in conformiry with Chspter 22?. Section 222.17, Florlds Statutes.
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~ I wai formerly a le~al ~esident of - 0~1~~~,~ _ 9ern~oa~
~ (~itY) (Stab)
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' end i~esidad at - BOft 11~5 Howsver 1 havs chanpad my domid{e ~
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~ to ~nd sm a~d have been a bona fide ~asWs~t of the Stats of Fiorida sinoe ~ day of ~
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~ I ~ ~ngnst 43 3S4 8htd~? L~as, ~i~er Park
~ , 19 , •nd 1 rsslde at
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I~ORT MERCE, SAINT LUCIE COUNTY, RORIOA
~nd tht: statement it ro be tsken as my declsrstion of citizenship, actval le~al residsnos and domldle in tfie Staro of Horida.
(Insert here any pertinent fscts, :uch a: sals of propeMy or bu:ine~s, or ~eltnqulihment of ~mployme~t "
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; st former domicils, romoval of family to new domiale, purchase of home, etc.)
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- ~ AND RECOROEp
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;~,y,~a~~~~co, ~v~ 1964 Jfi~ 20 AK 10: 38
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. . . ROGER POITRAS. CLERK
s~• LUCIE COUNtr, FIORfDA t
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I FURTHER CER7IFY that 1 will ropister at my local sddress whsn the registration books reo~pen, and oomply with
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all otfier ~equirements of a Ia~al rosident of this Staro. •
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t FURTHER CERtIFY that t have no intention ro retum ro my former doml~jle, and 1 lntend to mmein in fORI'
PtERCE, SAIWT LUCIE COUMY, FLORIDA, permanently. ~
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Sw~n~.~o and wburibsd bsfor~ rr~ this $Q ?
d,y of _ Jan~a r~r t9~..
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a D.C. My Commtuan expint
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(T. b. ~arNd i~ ~drpN~.1~. .wa ..ioiwal Awi willf ~'Irk anonc ~ew~, .nd drpua~. witl~ Ta~c As».~a