HomeMy WebLinkAbout2513 - - - - - - - - • - ~ - _ _ - - - ~ _ . ~
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Deci~r~tion ot Don~tciie a~d Citizenship
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~O THE STATE AND COUNTY TAX AS.S~SSOR, ,
'f ~ ST. ltJC1E COUNTY, FLORIOA:
, This is m~r dacle~ation of Donticils and Citizenship in the State of floride that 1 am filinq this dsy in eooordanos aRd
in oonformlty with Chspter 22Z, Secfion 22Z.17. Florida Statutes.
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1 was famerly a legal msident of ' `{F J ( Cl" ~U~- " ' ~ - s ~ J7 .
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. and i rosided at h / ~ t- Howsvsr t have chan~ed my domicite
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to and am and have been a bona fide resident of the State of Florida si~e °2' day of
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~ , 19 ` ` ~ and 1 roside st ~ / ~ • ~ ~ ~ 1~
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FORT MERCE, SAINT LUCtE COUNTY, FLORIDA
and this statement is to be taken as my daciafation of citizenship, adual le~al residenoe and domidie in the State of Horida.
pnsert here amr pe~tinent facts, such as sale of propeHy or business, or mlinquishme~t of employment
at former domkile, removal of family to new domicile, purchase of home, etc.) ~
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~ • ~ fItED ANO RE DED
QOOK
' 19b4 MAR -7 AM 10: 56
~ ROGER POITRAS, CtERi( ~ ~c,t~-1`(
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LUCIE C~UNTY, FLORIAA ~
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1 FURTHER CER?IFY that 1 wil - istr~t' -oarCA~Y ' ith
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alt othar requirements of a.legai msident of this State. ' • 'r
I FURTHER CERTIFY that 1 have rso intention to return to my former domic,ile, and 1 intend to ,remain in FORT
PIERCE. SAINT LUCIE COUNTY, FLORIDA, permanently. , r,
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. Sw~orn to end wb;aib~d ' .A .~~ht is. ~ day of ' ( 19 -
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ROG~ 'OiTRAS ~ ~,"+,t~~i
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CLERK CUIT COWM['_~ r .:~;:,r Notary Pubik
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gy , ' ~?~.C. My Gommiuion expires
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Re b..~.wha u~ a~~. ~ or~a.~ ~i.a-~h ct.~c a~n cov~, and dupliat~ with Tax,As+~ssora
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