HomeMy WebLinkAbout2632 Declaratio~ of Domicile and Citizenship
'i'O THh STATE: ANU t'OllN'fY TAX A~St:SSnR, 249s31
-~~.f. ~-C~+~!'~ COUNTY, f'LORIDA:
Tl~i. is my drei:~ratien of Uomicitr snJ Citizc~~~hip in the St.~t~ ot Florida th~!t ! am ~lipg this da~ in
accorda~tcc. .tnd in rontormity with Scrtion I i, Florida Statutes.
1 was torn~erly lrgai r.sidrnt ot' ~ E'_I I~-~
E-'-[L``----------- and I
(e5cr1 (s~a~ei
r~si~ied at _ -~2 ~ f~~ ~ a__ k- ~ _ - ~ - - Howe~~er. 1 have changed my domicile to
(Strr~t sed Numbr~)
;~ud am and hav~~ Ixen a bona tidr r~sid~~nt ot~ the State ot Florida since day oi
~c_r~__~_--_~_---- . 19_7L . and I msidr at _~_7~/S ~o-~a•w
- _ -~~i=- - -
~ (Stt t and Numbet)
C~--~1tu~~v_G~--Y~..~._-_ _ 1~tec.t.c - ~ f «c zv _ County. Florida,
(c'~t y )
and this statement is to be taken as my declaration of citizenship, actuai legal residence and domicilr in the State
of Florida.
(Insrr~ herr any prrtinrnt facts, sucA as ule of proprrty or businrss, w relinyuishmrnt of rmployment at formrr
d~micilr, rrmo~al ut family to new Jumicite, purch:?sr o( homr, atc.)
-~~-,s...~ ;,~.a-~'n ~ V1~4~- c~.:En~..~~
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FtL~O AM: i'ECO~OEp - ,
"ST.LUCIE G~li1MTY~~ /
ROGE? PJ~T,'rAS ~ -
ClERK C:i:Cl1iT 6(1±~ j~~
REC~=... •_r'~~~
~i[ 13 ~ ~ P~~';~ ,
~ 24~632
1 FURTHER CERTIFl' that I~vill rr~ister at my loral address when the registration books rropen, and
comply with all other rec~uirem~~tts of a le~al rrsident of this Statr.
I FURTHER CER Y that 1 ha~~e no int~ntion to return to nt~• F~rmer domicile, and 1 intend to remain ir~
-=-c_t'-`' t'~'-- - - - _ - • - - ~:1 T ~ ' -
_ C'o~intti.
Fiocida,.pecman~ntly. ~c;t.> -
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'~Skvorrrto a~1c}=su~'s~'ribed bcfor~ m~ tt~ix ~ clay of
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ROGER POITRAS Cle~k--_ - _ _ _ _
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(To t~e rzrculyd in duplicalr and un~~nal filad a.ith t'Irrk CircuA Court. anJ Juplicate ~~i1h 7ax Assess~)
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