HomeMy WebLinkAbout0201 Y
t~eclaratio~ of Dos~iCid~ ~,n~ Citizer~:;:~aip
30~~~0
TO THE STATE AI~D COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA: '
~
t
This is my declaration of pomicile and Cit~zenship in the State of Florida tnat I am filing this day in accordance and ;
;
in conformity with Chapter 222, Scction 222.17, Florida Statutes.
i
I was formeriy a ~egai resident of __~~~f~ _ ~Rnnj,~~~____
(City) (State)
and 1 resided at -----~~s'3_---------- However 1 have changed my domiCile
(Street and Number) ;
i
ro and am and have been a bona fide resident ot the State of Florida since day of
19~~, and 1 reside at _~'c~__ -
_
~ (Street and Number)~
~LC,~l~
~ SAINT LUCIE COUNTY, FlOr2iDA
and this statement is to be taken as my declaration of citizenship, actual legat residence a~d domiciie in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
1,~~ ~ ~a. ~~1Q.,~ fl 5~.... c<<.`~'o.r.°o , ~~ta.4 Q~ ~ Q ?
~ ~ f~
C/ ~ ~e ~J~.,d7~ o~t ~J~a.Qn ca. ~
(~1,.~.Q,,,.,,~ j Q~~ ~~k w~SLQ sD c~~~ 1 1971. -
~
3,~1 ~-g.~. ~~~~~~m ~ c~. ~ ~
~ n ~cZ`Z 2 1qZ ~ Qatid/ . 't
~~iCO''~~lee, J.~v~t-~O'dv.4 x ~ ~ . A~1~s~~t't/ti.~
.
q. ~ P~~t ~
~ a C a,~, ~~~,-~.~,~..4 A-",^~~ ~rQ68 cz..,,Q
O* ~ ~,,,`(Q Cti~
~ a,~ _
n.~.~-~ ~4~. t . . _
n ~rvY~ct~~ n.v~O~r,D ~-~.ran. ~ ~c~,~.Q~
~ ~ 0.
{
(
i
I
€ ~ •
59
{
E
g { FURTHER CERTIFY that I will comply with all other requirements of a legal resident of ihis State.
a
~
~
V 1 FURTHER CER7IFY that I have no intention to return to my former domiGle, and 1 intend to remain in ~
S~«~
~ SAINT LUCIE COUNTY, FLORIDA, permanently.
3
i
~
fILEO e.kD RECJRDEO ? :
~ ST. ~ IE .~HIT f~,A. . '
~ OCL-. t~JiTRAS ~,t.~ , l~ e) ~'/tij t G/~ !
~ c~Eax .:~::,UtT COURT :
~ RFCCk~ VF~ir~cp_~__%~~V- ~ COur'~~
~ APR ~ ~ 16 PH'75 ' ~
Addres
3~9'~'O ~a3- 6~_ ~,~~3
~ .
~ s4
~ Swom to and subscribed before me this j day of " , ~q~~
~
~ ROGER POITRAS . ~~L S SAF, MSC ~
~ CLERK C1RCl~IT GOURT d, ~ ~ ~
~ .
~
~ ' Surgeon Generdl ~
D.C. My Com sion expires
~ S~•?~*.+F'
~
(To be exacuted in duplicate and origi~a) ~led with Clerk Circuit Court, and duplicate with Tax Assessor.)
BOOK ~+e~(7 PAGE 2O~
i 3
k~ v.,% - _ '
~ ~ ' ' ~ ~
.