HomeMy WebLinkAbout0577 • 132~~
Decla~atlo~ ot Don~icil~ and Citizenship
• ~ ~ 128464 '
TO THE STATE ANO COUNTY TIU( /~~SSESSOR~
ST. llK1E COUNTY. RORiQI?; ;
~
Thit is . I
mp d~dar~tion of pomicil~ ~nd Citi~,~nihip in th~ Stab of Horida th~t ~1 am Hlinq thi: day in aooord~na and t
in confornwtp with Chapt~t 2?2, S~ction 222.17, Horida Statutts. ~ ~
;
Glendale. Long Isiand NeM YorY ;
1 was fornn~~iy a lpat r~s`d~nt of - ~
tGlty? tSta»~ • ~
~ ?219 62~d Street • '
.nd i hsid~ct •t 11ow~vK 1 hav~ charqsd my domWt~ ~
(Street and Number) ~
15 `
~ a and am .nd 1»v. b..n a bona fid. ~idant of the Staa of FI«id• sina day of ~
. i
October ~y~3 ~r~.~ i~~ ~~1105 B Colonial Rond ~ ~
(Stre~t a~d Number)
i
FORT MHC~. S/W1T l1,iC~ COtitiTY, RORIDA '
ard lhis statamsnt is so bs taken as my dedarition of dtizenship, ~cfual Ipal reside~os ~nd domicits in th~ Staro of HorWs. ~
(Inse~t hK~ ar~y pertinsnt facts, such a: sals of propsrt~r or bu:insu, or rolinquishmsnt of emplaymMt
at former domicile, rertwva! of family ro new domidle, purchase of horr~s, sfc.) ~ ~
~ Eatnblishing residsnce
:
0 RE~R~
04K
f11.E 6 ~
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6~ A,~ 25 aM ~ i -,e,~,.~st,., . - : ~ -
~9 F,aS c~ 326pp ~ ~ _
R~~~R pC°~~~y ~ Fto~~o FlC , D AECDRDED f.
. s~• ~s4 IN Rccc;3 BOOK f~+~.:~ . .
~'o ~ ,
~ 1965 JAN ~ 8 PM 33 ~
~ ~u~.r.
~
ROGER POITRAS, CLEit~
ST. LItCIE COUNtY. FLOR A~~ w~ r t~~~
:
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L~
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, ~ ~ V s ~R =
~
( ~R~ iF1~t ~ WI~~ ~ - Wjiks
all dfiK n~uirsrnents of a legal rosident of this State. , .L n;1~`~~~•:
• ~~~MUUN~u~~
I FURTHER CERTIFY thst i have no intention to retum to my former domidts, and 1 tnbnd to remain in FORT
PtEftCE, SAlNT 111C1E COUNTY, FIORIDA, permsnsntlY• ~
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sw~om b.r,d s~bsari-b.d b.fo.. m. thb ~5 d.y o~f ~°L ( t 9~
R08ER .
Ct~RK COlIRf ~ Notary Pubik
i ' D.C. Ntr ConxnlsNon ~xpM~s
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