HomeMy WebLinkAbout0929 Oeclaratto~ ot Dor~i~il• a~d Citizenship 152112
TO THE STATE AND COUNTY TAX ASSESSOR, ~
51. IUCIE COUNTY, FIORIDA:
This is my decla~ation of ~omicile and Citizenship in the State of Florida that 1 am filin~ this day i~ aaordsnos and
in oor~formity with Chapte~ 222, Section 222.17, Fiorids Statutes.
sr. rxa~u?s vlRan~ zsr~?xns
I was formerly a legal ~esident of ~
~~i~y~ tSta»)
and I residad at 4~ kospital (31'otuld , However 1 have changed my domidle
~ (Street and Number)
to and am and have been a bona fide resident of the State of Florida since lat day ~
J~~~ _ , 196? , and I reside at 1006 S°a~r Dr. ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIOA j
and this statement is to be taken as my declaration of citizenship, actual leflal residenoe and domicile in the Stete of Horida. ~
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(Insert here any pertinent facts, such as sale of property or busineu, o~ telinquishment of employmsnt ~
at former da:~icil~, removal of family to new domicile, purchase of home, etc.) ~
i~ Filing for hamestead purposes ~
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FlLE~ AND RECp~tO ~
s7, WCtE COUMTI?• p - . '
RECORp {/EAIFI~O ~ : C~~~'~`~ ~
~l JAIy 23 pW ~ ; y9 ~
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~5211~ ~
ROGER POITRAS "
~l.EAK CIRCUIT CByI~ ~
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~ 1 FURTHER CERTIFY that 1 witl oomply with al) other raquirements of a lepal reside~t of this State. ~
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1 FURTHER CERTIFY that I have no i~tention to return to my former domicjle, and 1 intend to remain in FORT ~
~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. '
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. ~ (Name) ~
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;;;~i+rr~;;., xilton J. Roaenau t
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=;Syyo~rr~"~+d subscribed before me this 23~ day of J~~~_ ,~q 6? •
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Cl~RK C CUIT UltT Notary Public '
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gy O.C. My Commission expires
(To b~ ~x~cuhd in icat~ and ori~insl fil~d witi~ d~lc qrarit Cou~f, and duplicai~ with Tax A~aor.~
~164 ~ 928
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