HomeMy WebLinkAbout0588 ~ ' .
Dacl~~atlon ot Oomictle a~d Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, -~-~~4
Si, ltiC1E GOUNTY, FlOR1~A;
This is my decla~ation of Domicile end Citize~ihip in ths Stat~ of Ftorida that 1 am filin~ thi~ day !R aooordana a~d ~
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in oo~fo~rmity with ~hapter 22~. Saction 422,17, Florida Statutes. ~ ~
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1 was formerly a leyal resident of W311ard _
(CitY) lSfah)
and 1 residsd at ROUte 1 . flowwK 1 h~w ths~~sd my domWl~ ~
(Street and Numbe~)
ro~nd am and have baen a bons fid~ rosid~nt of the State of florida sinos 1 day af -
~~~r , 19 6, snd 1 mside at 310 St. Luda Ls~e~
(Street ~nd Numb~?)
!`CRT r1~C~, SAINT lUC1E COUNTY, RORIDA
and this ststement is to bs taken as my declaration of citizenihip, actual Is~al residsnos ~nd domidle in th~ Sta1~ of Horida. ~
(Insert here any pertinent facts, such as s~le of property or business, or ~elinqui~?m~nt of employm~nt
et former domicile, removsl of family to new domiciie, purchsse of homs, etc.) ~
I Eetabliahiga reaideacy -t~i~4~ -
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. ROGER POITRAS. CIERi(
ST, LUClE C01lNTY, FLORIDA ~
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1 FURTHER CERTIFY that I wiil regiiter at my bcsl addreu when the ro~isnation books ~eo~erit • ~±ti'
all otF~ regui~ements of a le~a! rasident of thi: Stals. ~=:i t''~~:11 n~`~~9~'~.~ ~
ryd - •'1,~~.~-y, ~'~'~vw.~..~ .
1 fURTHER CERTIFY that 1 have no intention fo ~etum to my former domidle, and 1 intend to ~(Irm~i1~i.;in.,F~itT`:..'~ .
PIERCf, SAIfVT LUCiE COUWTY, FtORIDA, permanently. ' ~ ~
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`f~ • ~w'•. ~ (Name)
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: . Cortr3n ~sarlea
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. :z: ~~!d.W~scribsd befor~ mt thi: 28 day of J~ 19...~..
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ROGER fpITRAS ~
QFRIC CtRCWT COURT Notary Pu [ i~i~
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~ Sf? D.C. My Commiuio~ expiros
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f (T~ b~ ~oc~euhd b ~nd ~
~ dvpqc~l~ ~riaieai Hl~i wi11~ CM~Ic CM~crit Gwf, ind dupNcal~ wi1M tax A~~J
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