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~ Declaration ot ~omictle a~d Citi:enship ~
. TO ~ THE S~ATE AND GOUNTY TAX ASSESSOR. . ~ 3239p -
S1. WG1E COUNTY, FIORIDA: ~ ~
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This is my decl~ration of Oomkile and Citize~ship in the Stats of Fiorida that 1 ~m filirp this dey in aaoordana a~d
? in oonformity with Chapter 222, Section 222.17. Florids Statutss. ~ .
~ I wat fotmsrly • leqai reside~t nf MontreAl ' ~ Cariada
tCiy) (5tah)
and 1 rosid~d at l.~,~+,,y~„~ ja~~.. $.t MowevK 1 have chupsc! my domWle
(Strest irid Number)
b a~d am and haw been • bons fids rosident of the State of Florida sin~s 12th. ~y ~
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bctober » 63,~ ~t ~~3_~r~a Stse=t
(Sheet u+d Numbsr)
l~ORT NIERtE. SAINT LUCIE COUNTY, FLORIOA •
~nd this ~feternsnt Is ro bs taken as my dederstion of citi~snship, actu~l legal residenos ~nd domicile tn th~ Stat~ of Horida.
pnsen hare any pertinent facts, such as sale of property or buiinsu, or relinquishmsnt bf employmsnt
. at former domicile, renwval of family to new domicile, pu~chass of Iwme, Nc.) ~ -
~ - 1323~0
: Bstablishing residencq ~M a~N~D R~epRp '
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: . St. ~UClf COUNTr F[0 ~
.~~lien ~ A 10 359 830 R~~A ;
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' ''~..,',p,~,tRTHER G~TIF1f that 1 will oomply with all othsr roqul~r~ents of a Ipal residsm of tfits Sta». ;
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j i fURTHER CERTIFY that I have no intention to retum to my former.domidle, and 1 intend to remsin tn FORT
} WERCE, SAINT LUCtE COUNTY, H.ORIDA, permanently. ~
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~ ~ c,~;•:sf ! Jean Vuy Gagnon -
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ro~ii~d•~i?bxribsd b~for~ me tfiis Rth d~y Januats., , i9 b5_ ~
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CIRCUt;,/COURT Notary Publk 1
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~ D.C. O My Canmissbn expires • .
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i R• •x•w~.a b~ ddp~..ea .~ei~inal el~d ~vlth a«tc ebadt cew+, ana a~at. wi* T.o~ A.»,.era ~
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