HomeMy WebLinkAbout2973 4!
~ 'f
Dectaration ~t Domicile ane! Cltl~e~nship ~
'I
~
TO TNE STRTE AND COUNTY TAX ASSESSOR, ~ . -~-3~~i~~ ~
. ~
~ S'(. IUCIE COUNTY, FIORIDA: ~
~
! This is my declaration of Domicile and Citiienship in the State of Florida that I am filing this day in accordance and ~
~
~ in conformity with Chapter 222, Section 222.17, Florida Statutes. ~
. 1
~
~ Norwa].k ' ~ Conn.
I was formerly a legal resident of (State)
. tC~~~ , ~
; ~
~ and I resided at _ 48 ~St St. Hawever 1 have changed my domic~le
! (Street and Number)
's
~ to and am and have been a bona fide resident of the State of Florida since 2nd July day of
~
~
, i9 64 and I reside at 210 Aizoso Blvd. Pt. St_~ Lucie ~
} . (Street and Number) ~
~ FORT FIERC~, SAINT WCIE COUNTY, FLORIDA ~ i,, '
f f nd domicil'e ~l Steto of Horlda. ~
? and this statement is to be taken as rrny declaration of citizonship, actual iegat residence a ~ ~
: . - ~
~ ~
€ (lnsert here any pertin~nt facts, such as sale of prop8rty or business, or relinqui:hment of ampioyment
' at former domicile, removal of family to ~ew domicile, purchase of home, etc.) j
~ _ ~
; . . - ~ ~
_ . New Domicile . . . - i
~ _132~26 ~ , ~
~ ~ _
- }
~ ~ . '•a f- ~
. • . . . . • . ~ ~I
. ~ . ~~~1 .
~ . DED ~ , ' . ~ ~
~~~i~P~~ ~ooK . j
- IN~,,.~..~-- . ~ ~ ~ ~ y . ~
~ _ 1965 J~?N -4 AM I ! : 56 ~','n ~ ~
,l , OJ•'•......• ~ ~
~ IERK ~ . ' f
ROGER POITRAS, C ~
! ~ ST,~ LUCiE COllRiTY; flORIOA ~ (
~ . ~ _ ~
t~ . :
. . . - . . ;
. ;
Ej ~ . - ~ s~
_ ~ T' y
1
9 ' '
, I FURTHER CERTIFY that I will oamply witfi ail other rcquirement: of a leyat r~tdent of this Staia.
i~ • ~
~ ~
.
s; .
I fURTHER CERTIFY that~ I hava no intention to return to my former damic~le, and I intend ta remain in P4RT
~
~ ~ PIERCE,~ SAINT LUCIE COUNTY, FLORIDA, permanentiy..
~ ; ~
_ ~ ~ - ~ !
; i. f . ` . 1 .
. , ~ . . ~J[!'i.c " ' ' -
~ t ~ ~•~;,l~ii . i
~ • - . . (Name) - - ~
{ i ~ ' . . _ ~
3y ' ~ ~ ~ ~ •Jr ~ ~ . . ~
` ,~-c ' Whitn~Y
: ~ , _ ~ ~ Mildred P.
` ~ f - 4 ~t~r-:~: I (Addres~) -
F ' ~ : ~ . ti.., . • ;
~ • , , .
£ ~ i r 65
~ ~ 4~ JanuarY , t9 .
~ =~'worn-to and suburibed before me this day of
~ ~ ~ -
I ~
~ j ROGER PQtTRAS
~ t~RK CIR~WT CQURT ' Notary Pubiie ~
~
C
~ ~
~ ay _ p,C, My Cammission expires '
~ _ ~
g i
~
~ • - ~
- ~ ~ .
(To b~ ~x~cu~sd in duplicaro and ariqinal fil~d with CtKic Cl~it Couh, and dup{ieafa wieh isx Assos~ar.) ~
;
, f
~ eo~K ~07 F~cr ~72 . , .
. ___.y__._____ - . `