HomeMy WebLinkAbout0509 ~
i22645 ~ i~
Declaratio~ ot Domicfle and Citizenshlp
TO THE STATE AND COUNTY TAX ASSESSOR, , ~
ST, IUCiE COUNTY, FtOR10A: ,
This is my decla~atio~ of Domicile a~d Citizenship in 1hs Stats of Fiorida thst 1 am filinq thts d~y in ~ooordae~a and :
in aonformity with Chapter 4Z2, Sectio~ 222,17, Flo~ids Stetutes.
~ i was farmerly a legal rosident of ~I~~ _ ~
(Giy) (Sta~s) ~
ZL~!'l70? N. l~e~stoae ~ve. i'
and 1 rosided at . However I tuve chan~ed my domidle i
(Street and Number) '
~ to ~nd ~m and have been a bona fids resident of the Stats of Florida slnce 28 dey of
~
I"~~ , 19
6~, and I reside at 610 TeJCa~ Crt. -
(Stroet and Number)
-
FORT N~~, SAtNT WCiE tOUNTY, RORlDA - ?
.
and this statsment i: to be taken as my declaratio~ of citizenship, ectual 1a9a1 ~esfdence and domldle in ths Stsro of Horida.
~
(Insert hsre any pertinent facts, such as sale of property or business, or relinquishment of employme~t
at former domiciie, mmoval of femify b new domicile, purchass of home, ett.)
; , ~ .
, , a ``~w'~~ ~.Ow::~. ~e~~= .
_ . . . _ ~~~N~ v~~~ ~,i v~.i:.. _
.;t~.,,:a . ~ . . . .
. ~ -
• roR x~~n ~o~osES ~:~_„~~:.•.S
's:.~~.: ~ . ~ : a . -
: ~ '~z.;<.~~'y,::,:: ~ :l'=• S~'_~ .
: - ~ • o ~l~;;a_ ; ~ ~ ~ y1 s. ~ . _
r:~ ; " ~
;
' i22645 _ d ~`i . _
i _ a -
~ O •.,11~f1~:'~'.•:
~ -
.
F1LF A D RECO OED ~'-'~1?.~n a~~
• ~ u!',~,a,R~- • ~ ~
~~BDOK . -r~. _ =r;. ~ :
1954 JM~J 2S A~! I I: 21 . ~t : . ' .f ' ~
ROGER POITRAS, CIERK
. ST. lUCif COU+ITY, FLORIDA ~ ~
; 'r
:
; I FURTHER CERTiFY that 1 will rogister at my local address when the regisnation book: reopen, and aomply with R:;~-
~ aU ott~ roquirements of a legal resident of this State.
. ~
1 FURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT ~
~ :ti.
PIERGE, SAtNT WCIE COUNTY, FLORIDA, permsnently.
~
; Q -
~ , ~ . n'' .
; i ~ . CV ~ T: 6•pG (Name)
~•r'` ~
~ ,~~c....u 9.~~~
: ; v , . -
j ~ ;r ``p:;y ~ c~oac~B a. ao~rn~x
. s ,
' a: . .
~ `.i a:~g'Z:w:.~. '.n.t~;'~"-.,
~ ....:-a-:~ ';=.1~ : (/4ddress) ',;s
t71. t.:'~ . r. ~'~~.T ~ ~7~ • • ~ ; .
~
_t ~ ~ ~ w.~'r •r ~r : • ~
r . r.r , . : . ~ '
„1f'~ t = j ~~N~~~• e.~ ;
~ . ~,'~C~ ~?.-~.,~`.r.~.,!Fo;~odrsubsaibed befor~ ms this ~ day of J~n~ , 19~~ ~
; .s''-'~.
f~y~,":;~M
X,~'.y.~rT ;
+ "'~~.i t*'~: ' • " .
~ .i.!-• -.RQaER ~011'R/1s ir,.`r
C!R COUR? Notary Publk
f ~ - -
;
8~? D.C. My Commiuion-expiros ~ . ;f
i e0~~ ' _ . ~GE O~
~ 1. (i1.
~
~ ~Te b~ n duplicab and o~in~l Bl~d wiN~ d~lc Cirwif Cour~, and duplical~ wi~h Tax A~aasra ~
i
~
!
- • - - - _ _ . _ ~