HomeMy WebLinkAbout2696 ~~{'~t1011 OR ~OI~I~~ alffl Ci~iM~hl~
.
TO Ti~ STI?TE MIO GOUNT1f TAX ASSESSOR. ~~4
• r.
s1. iun~ couwnr. aatiu~ ~ ~
This i~ my dscl~ntion of Oomkil~ and qtiz~hip in th~ Siat~ of Horida that 1 am filinq thb d~y in aooordu~o~ ~nd
in conformity with ChaplK 2Z2, S~ttio~ 222.17, Fiorida Statut~.
l .
- 1 was formerly a leqa! resid~nt of ~
. C:O. - ~ .
and 1 rosidsd tt _~~~'r/ s,l~~ . How~ver 1 have dNrq~d my domWk
(Stt~ a~d Number) ~
~o and am and Fave baen a bona fid~ rosid~r~t of the St~» of Florida sinos ~+Y ~ .
~ . .
, 19~. and 1 r~side at
. tStroet a~d )
FORT COUNTY, RORN~A -
and this statemenf is to bs taken ~ my daclaration of dtimnship, ectual le~ai resid~noe and cbmicile in th~ State of Horida.
pnsert here any pertinent fac~a, such ss sak of property or businass, or rotinquishm~nt of empioyment
st formsr domidle, romoval of family b ~ew domicik, purchass of home. etc.)
.
~ .
- ~L
. - ~ F~~o~,~+,o R~coRO~o~
ST. I.UCtE COUNTY. Ft~A~
_ RECORD' V~I~IED ~
.ia7t),~N ~ .
. '10 JUL I 7 P~! 3: 2 2.
- ~
ROGER POITRAS ~
_ ~ CLERK CIRCUI.T COURT~
1 FURTHER CHtTIFY fhat 1 will corr~ply with sll o~ nquin~wnts of • Ipal ~~id~nt of thtt Stab.
1 ~ CERTIFY thet I have no intention to roturn to my former domicile, and I intend to remain in FORT
.F,:.~'...; ' ~
Pi £QIJNTY. FLORIDA, psrmanently.
~ ' .
~~~t~~~i~~ ' w ~
,Y a~t ~ ~ i
~•'1 ~T'NNf~i~ ~ - ~Y~ IJ
r . ~l ~
~ k:-3y t~.i'~"5!. y • " ~
~ f . .
- §~+Q~r- ~'~a' i~
' Yf.. ~ !'i;~-•.~?~
~.'3 ~ p i' .
•:~w # J . •
X-- ~
.%1 ._S~..s'~•7,~tr~~ :,.'s
7
.
' ~ # ~ ~ ~i-~ -
~ y i 3, !
',h. -.~it~~.;d'~ ~~'Zi}"_._~~, ~ - .
~ # - -
~'~*`yf : - ~ ~ il~~
~g
r ~ _
• . ir- - / / p
?~ZN~~~ ~fld f1J~U1~d ~OfA fY1f 1F1jf ~ 19 •
~ ~
PN~IC
o.c. MY c«,~~+
R. r..~o.ou~.~ M~iieM..~i «~iw.i a.~ wMM ~cM~k araU C.w+, +~i +rrlial~ wi1M T.~c A..«...a
~i85 ~~1~
~s . . . . _ . ~
. 4. ~ _ -
.
_ - ~
.