HomeMy WebLinkAbout2795 ~ {
• De~la~ratlon ot Clomicile at~d ~ttiaer~ship ~~3''~~~~ c
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YO THE STA~E ANQ CC~UNTY TAX ASSESSOR, I~
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ST, WCiE C4UNTY~ FLORID~i: l`
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~ This is my declaraiion of Domtcile and C:itizenship in tha State of Florida that f am filing this dey in auordance and ;
~ In rnnformity with Chapte~ 224, Settion 222.17~ Florida Statutes. 'i
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• I waa fo~marly a legal resid~nt of ~Y'xNGTUN • VA.
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~ . 4030 N. Giebe Rdo
~ and 1 res(ded at . Howeve~ i have changed my domiule ~
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ro and am snd hava been e bona fide resident of the State of Florida since 25th day of ;
D~c~mber 64 ?203 S, Yndi~n River Dr,
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FO~t PIERCE, SAiMT RUCtE Gt~UNTY~ FLORlDA ~
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~ and thi: statement is to be taken es my dectarotion of citizenship, actuai legal re:ld0nce and domitile in fhe State of Fto~ida..
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? (Irisert here any perilnent facts, suth as saie of property or business, or relinquishment of +~mpioyment ~ . `
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I ' at former domicile, removat of family to new domicile, purchnse of home, etc.)
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; . ~STABLISHING RBSIDENCB .
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_ . . 1964 DEC 31 Q~ ~ i. 32 .o ~ ~ . 0 .
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ROGER POITRAS. CIERK ,~F_~„?, ~,~N~~~~,,.~
' ~ S~. IUCIE COUNTY, FLORIDA .
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I FURTHER CHtTiFY tfiafi I wilt oomply with all other requiromenn of a leqat resldant of tfils Stata. ~
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' , i FU~ tHER CERTIFY that I have no intention to return to my former domi~ile, snd i intend to ramain tn F4R'f
1..~ PiERCE, SAINT LUCtE COUNTY, FLORIDA, pe~man~ntly.. `
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• RA iOND R. BLU~ .
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and :Ubscr~bed before me thia 31St da of December 19 64 .
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. CLER CIRC i COURT _ Notary Public ~
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~ 8y D.C. My Commissto~ expires ~
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3•-_ tTo bt ~x~evhd n dvplieats and orlyinsi fll~d with C{~e~lc qreuk Gwet~ and dupiiah whh Tax ~.I
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