HomeMy WebLinkAbout2971 Deciaration o! Domicsl~ ant! Cititenshlp 13222~ ~
T~ TNE STATE ~?ND COUIdTY TAX ASSESSOR,
Sj. WCIE COUNTY, FLARI~A: ' ~
. ~
. Thls ia my detlaration of [7omicile and Citizenship in the Stete of Florida ihat I am flling thit day in eccotdante and ~
, ~
in conformity wit~ Chapter 222, Section 222.17, Florida Statutes. ~ ~
~
;
t ~
Baltimore ~ ~aryiand ;
1 was fo~merly a legat ~esident of ~
(Ciry) (Stata) i
~ ' 1256 Vo t Avenue ~ ~
~ and 1 resided at ~ Howeve~r I heve changed my domidle
. (Street and Number)
b and am and have been a bona fida resident of the Stafe of Florida_ sinco lOth day of '
~
~ _ ~ ;
~ i~' ~ 128 Bsti~ ~ane, Port St. I.ucie ~
R~ ~ January ,~q 64, and I reside at
(Sireet and Number)
I ~ ' fART PiERCE, SAINT lUC1E COUNTY, FLORIDA ' ~
and this statement is to be taken as m~ declaration of citizenship, actual ~legal rosidence and domicile in the Stata of Horida. ~
- • :
~ (Insert here any pertinent facis, such as sale of property or business, or relinquishm~nt of emplayment ~
at former domicile~ removal of famity to new domicile, purchase of hnma, ete.) !
!
1
~ ~ ~ .L3~~~?c~ (
~ . . - {
FILED AND RECO~ED !
. '
~ ~ ~ ~001~ .
F 1965 JAN -4 AM i i: t s '
~ ~ BstabZishing res~dence ' . ~
= ROGER POITRAS, ~LE(~K ~ I
, ~
' ` ~ ST. IUCI£ COtlNt1', FI.ORIDA
.
i ' ~ .
i ',``,..~~?t~~uu,,;~~'
~
~ - • ~ o..... ~i~~• r
,
. _ ~ ' % i
; - ~ ~ • . -
, ~ . v, . . ~
. . .
~ , . ;t~:i,~ :>i ~ : : _ ~
~ - .i ~ 3', .~i : ~ ~
.
~ ' _ ' ~ ' ~
s ~
/j '?r . . ' 7 ~
~ , n ~
~ ~ - ~1r,~ •7 1 ~ f~ • !
~
i FURTHER CERTIFY that 1 wili compiy with al) otfier ~equlr~ment~ of a leqal resldant of this~Steh:
. ' " ~
~ ,
~ I FURTHER CERTIFY that 1 have no inteMion to retutn to rny farmer domic~le, and I intend to remain in FORT
, a =
PIERCE, SAINT LUCIE COUNTY, Fl.ORIDA, permanently. . _ i
` . , ~
t~ ,...,~~i~i~„ ~ ~ ~ i
` ~ - - ~ GV 1 T CO'~~,. . . ~ . (Name) - f
~Q, G , ~ ?
,1 ~ r. ~ ~ .
. c
_ R;• ~r-,... ~ f :
; ~ y .~,,t e = ~ ; sr" Arthu~r O, Sfran z ' ~
~ !
' ~'~ri..~ ~ r'",-, _ ~1 s (Addross)
~ :l ' - ~
ii r N r ~
i ' 7~?'' ~'i
s :
'\Y • - - i
~ `-r . t~ 4 ~ January 19 '~5 ~
~ . ~ ~ , ,
''~i,L6~~n~ar~d subscribed before me thia d~y of , ~
~ - . ~
,
t ~ t I~OGER POITRAS .
r;~ RK CiRC T COUIFT Notary Public
3 ` _ .
~ gy D.C. My ~ommission expires
0. R: .
~ ; . 8~~; X ~O~ PACE~~ .
r ! . ~
.
.
(To b~ ex~cut~d in dupliu~ and ori~inai fi{ad witl~ ~ Cin.~t ~Cou~f, ard d~pttcah witl~ Tau A~aor.1