HomeMy WebLinkAbout1846 ~ ..ya.*w ~.s~»~^~'~
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Declaration ot Domicite and Citizenship _ i;
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TU THE STATE AND COUNTY TAX ASSESSOR, 1~iQ4
ST. IUCIE COUNTY, FtORIDA: ' :
n i in ths St~ts of Florida that 1 am filinq this day in aooord~na and ~
This is my decluatio~ of Oomidle and Citlm tl+ p ~
i~ oonformiry with Chapter 2Z2, Ssctton 222.17. Florids Statutes. ~
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1 was formerly • leqel ~esident of -
' (Ciy) (Sta»)
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~~d I r~ided at •
(St~eet and Numbsr) -
~o a~d sm and have been a bona fids rosident of ths Stste of Florida sinos ~ day of
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~ 19~, and I reside at
, (Sttset and Numbsr)
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ro~ N~, s~?i~ iuc~~ couNnr, aoRro~ -
and this statement is to be take~ as my declaration of citizenship, actual legai residenos and domidls in tfis State of Horids.
(Insert here any pertinent facts, auch as sals of property or business, or rslinqulshment of emplaymsrit ~
st former domictle, mmoval of family to new domicile, purchsss ot home, e.)
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1964 AUG I 0 PM .3: 30
~ - ~ ? ~ ROGER POITRAS. CLERK -
•r. • i
r~.~,-F.t1t: ~ SI. IUCIE COUNTY, FLOR A
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1 FURTHER CERTIFY tfiat 1 wlll ~^^~Y Wi~
all otF~x ~equireme~ts of a legal resldent of this State. ~
I FURTHER CERTIFY that I have no intention to retum to my former domir~le, and I intend to ~emain in FORT
, ~ PIERCE, ~Alt~(T LUCIE COUNTY, FLORIDA, permanently.
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' Sworn to and subsuibed before me thi: day of 19~ .
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' ROGER rOITRAS
~ ` CIERK CIRC COtJRT Notary Publk ~
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~ gy D:C. My Commission expires
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(To br ~x~cul~d in duplic~ and o~inal Al~d wifb Cl~ric C•ira~it Co~~, and dupikat~ wiH~ Tax Asa~aa
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~ $a~K 9fi ~5
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