HomeMy WebLinkAbout0939 . Y
Declarateon o! Dorr~nicete and Cjttze~ship
• TO TME STATE AN~ COUNTY tAX ASSESSOR, ' ~1~6~~
IGr
Sl, lUC1E COUNTY~ FlOR1~A:
This is my decla~ation of Dom~cile and Citizbnthip in the St~t~ of Florida that I am filinq thii dey i~ ~a~o~d~ncs ~nd
~n conform~ty with Ch~pte? 22~, Secrion Z42.i7?, Flaids Statutes.
1 wei form~rly a Ip~l reside~t of _ ~ ~ ~ ~
tC+h) (St~t~)
and I nsided at How~vK I hav~ cMnq~d domivli
^~Y
(Str t and Numbtr)
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to •nd ~m •nd hav~ boen • bona fide residsnt of tha State of Flotida ~inu ~ ~ d~y ot
A~b . ~9.~. ~ .1 ~
5~~~/~R , ,S'~"
. (Str~et ~nd Numb~r)
fORT PlERCF, SAIN? LUt1E COUNtY, FIORIDA
and this stateme~t is to be taken as my decla:atien of citizenship, ~stuel I~y~l ~etidenu and domicil~ in tF?~ Stata of Hotida.
(Insert he~e any p~rtin~nt facts, :uch st ~~ie of property or buiin~s:, or tsli~quiihm~~t of ~mploym~nt
at formK domicil~, ~~mov~l of family ~o n~w domicil~, purchas~ of han~, Nc.) - .
C -,Q~_~2~~C.7 ~ ~f -G~-F ~'-C.Gx-~~ -
% FItEO AND ?ECOAQf~
j :T. LUCIE COUMtY F~
- - 1106ER ?OiTIIAS
CIERR WNCUIT COU11T ~y~( ~
~ RECORO YER~FtEO.r.,.~.i:'~
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1 fURTHER CERTIfY th~t f wil{ aamply with a11 ottt~r nqui:arr?eals of • I~qal ~Kidsnt of this Stat~. ~
1 FURTHER GER7IFY that 1 have no intention, to rstutn to my 4armet ilomic,il~, and 1 int~nd to ~~main in FORT ~
PIERCE, SAIN? LUGE COUNTY, FIGRiDA, psrmar?~nt~y.
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~ 3wofa to•end substribed bsfo~~ m~ thi• ~ d~y of , 19.,~.
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~ ROGER POITRAS - ~
C K CiitCU1T OURY Notary Public
8y D.C. My Commis:ion expirei
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(7o b• ox~cuted in dupliuto •nd ori~ina! ~lad wit#~ Ctsrk Cirwit CouA, •nd dupllue~ witb ?~x-Ass~ssor.j !
r« ~00~1~'1 ~ ~37 ~ ~
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