HomeMy WebLinkAbout0190 ~ _ .
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~ Deciaratlon of Domicile and Citisenship
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~ TO THE STATE AND COUNTY TAX ASSESSOR,
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4 ST. lUt1E COUNTY, FLORIDA: j`
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; , This is my decla~ation of Oomicile and Citizen~hip in th~ Stat~ of Florida that 1 am filinq this day in aooordana a~d
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~ in oonformity with Chapter Z2Z, Settio~ 222.17, Horida Statutes.
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~ 1 was formerly a le~sl residsnt of ~~BDiiTt _
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i •nd 1 rosided at 1a7 Nelsoa Stre~t . How.~?sr ~ haw cha~ed my dom~dk -
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~ ro and sm a~d have been a bona fide res'ident of the Stete of Florida slnos dth day of
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~ 'T~ ,~9~ , snd 1 restde at 708 30 31st ~t7~eet ~:s
(Street and Numbsr) '
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I~ORT M~CE, SAINT ItICIE COUNTY, ao~~
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~ a~d thls statement is ro be taken as my dedaration of citissnship, sctual le~al ~estdenos and domidle in ths Stat~ of Horida. ~
pnse?t her~ any pehinent fact:, such u sale of propsrty or business, or rolinqulshm~nt of ~mplaym~ot '
~ et former domicile, removal of family to rew domicii~s, purchase of hotne, etc.) i
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! E~nLering Jerry Yiohoel R~oberta ia the~t~ grads
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~ " >1lred C. Jr. ia the Sth grade
i ~ " Cst2~ sn~ in the ~d grade 43
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° ` " Q~rr~ Ia?an inthe Srd grads ~ E~~~D~p ?
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~ ~I~t~~ BOOK
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~ • ~ ~ CIERK
~ ::'s=~~.~f~~•~ ~ • - -Rp~ER POtTRAS• A
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- : s:;;.:~i~a.~'r . St. lUC1E COUNT'!. f LORID
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i~URTHER CERTIFY that I will ro~ister at my loal addr~ss when ths roplstration books reopen, and aomply wHh
all other requirements of a le~al ~ident of this State. ~
I FURTHER CERTIFY that I have no inteMion ro roturn to ~r former c3omiCile, and 1 intsnd to rsmain in FORT
PtERCE, SAINT LUCIE ~OUNTY, FIORIDA, permanentiy.
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~ ~ltrsd Robsrtis ~
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sw~n to and wbsc~ib.d b.for• m. this 80tr~•:;,,;;;;~,~~ ~ T~auas'~ ~q 6~,-
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OJ~:~~OUE'~'b'y•t:
ROO~ ~OITRA: '.a :
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C~CUR i.
a:;~'1'-?:: Notary Publk ~
C7~ a ~ !ti' ~+t ~-r •
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S~?~,! _i ?:;'."'~.~nbsion ~xpires .
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4.,,~ :79 ~~19p ~
(Te b~ ~oawhd M dupiic~h aed ~i~al f~d wi~ C1i~~'c"'tMaiif Cewt, aad drpiicaN wilh Tax AsMMer~-~-- ; L
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