HomeMy WebLinkAbout2970 . ~t
. ne~clara4ion af ~om~cile and~ ~tttzena~ip ,~32~~~ . !
' TC) TNE STATE AN~ COUNTY TAX ASSESSOR,
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ST.~IUCIE CUUNTY, FL~RIL~A: . ~
i . This is my declarotion of Domicile and Citixenship in the Stete of Fforida thbt I am fiiing this day in actordance and ~
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in conformtty with Cha~te~ 22?, Section 222.17, Florida Statutes. i
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; I wbs formerfy a legal ~esiderit of g»f.~814_ ---HP~'' ~1..~--k--
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~ ~ and t roaided at 616 Tacoma Ati,enue . Howev~r I have changed my damiClle ~
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# ro end am and have t~an a bain fide resident of the Stata af Fiorida since 15 , day of
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Decembex ~ 1964 ~ end 1 reside a~ $~6 Camincb Drive f
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FORT PtERCE, SAINT LUCIE CQUNTY, FtORIDA ' `
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a and this statement is to be taken as my deciaraSion of citizenship, actual Iega! reaidente and domtcile In tha State of Florida. t
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f (tnsert here any pertinent facts, such as sale of property or business, cr ralinqulahment of ernploymant ~
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~ at forrtier domicile, removat of family to new domic+le, purchase of home, etc.) ~
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bstablishing residence ~ ~N ~E"!i1 ~CC4t~ `
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F
i 196S Jl~f~ ~4 AM ~1: ~ S ~ `
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-ROGER POITRq$, ~lER1~
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1 FURTHER CE~tTIFlf that i witl comply wlth el) o~har requirements of a le~s! r~ident of thi: Stete.
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I FURTHER CERTIFY that I have n~ intenfion tc rotum~ to my~ forme~ domi~ie, and 1 intend to remei~ in FORT !
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PtERCE, SAtNT IUCfE COUNTY, FLORIDA, parmanently.. . ~
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pG•-,~ . -
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~ :j : ' . n~: Floyd B,. Benner, Sr. :
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o•arid~subscribed b~efore me thls 4 day of J~ ~ ry ~ ~Q65 , i
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; ~ p ROGER POITRAS ' _
. l,ERK CiR UiT COURT ~ Notary Publi~ #
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~ By _ D.C. ~ My Commission expires ~ ~
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~TO ~~XAICIHK~ I~1 iOY~fOItiN •TI~ W"~~IM{ ~I~ WI141 COS1'I~ C~fCY~! COY/1~ and ~fuplicats witb Tax AtMaor.~ ;
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