HomeMy WebLinkAbout0526 . ~
DeClaration ot Domtcile and Cittzenship
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~ TO THE STATE AN~ COUNTY TAX ASSESSOR,
ST. IUCIE GOUNTY, FLORIDA: ' -L~r~j~
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Thii is my declaration of Domicile and Citizenship i~ the Stats of Florida that 1 am filinq this day tn aooordano~ and ~
in oonformity with Chapter 222. Section 222.17, Flaida Statutas. ~j~
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I wss forme~ly s legai ~eside~t of ~'~e _
(Ciy) (Sta»)
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and 1 rosided at ~ute 2 , Flowever 1 have chanqed my domWis '
(Street and Number) ~i
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to and am and havs be6n s bona fids ~esident of the Stats of Florida sinos ~ day of
Septeawer 63 503 '+~ieteria
, 19 , and 1 reside ~ et ~
(Snaet ~nd Number) "
I~ORT MERCE, SAlNT LUCIE COUNTY, RORIDA a
and this statement is to be taken as my daclaration of citizenship, sctuai legal residenoe a~d domidle in ths Sta1s of Ho~id~. -i
pnsert here any pe~tinent facts, such as sale of property or business, or ~elinquishment of empfoyment
at former domicile, removaYof family to new domicile, purchase of homs, etc.)
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petablish~g residency _FlLED A~:D R€~ORDED
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~•r`~CU ;COG~::~'`- ROGER POITRAS, CLtfiK ~
~=,~{~;~;:SV~~~:~.T~;= ST. IUCiE COUNTY. FLORIOA ~
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1 FURTHER CERTIFY that 1 will register at my locat address when the registration books reopsn, and oomply with
all other roquirements of a legal resident of this State.
1 fURTHER CERYIFY that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT
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PIEt~F;;~l~j}.~~ OUNTY, FLORIDA, permanently.
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' - R - j'' ~ - p (Name)
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7~r'~":i~~ ii:.:.:t-~•' . - ~ : -
. _ ; ~ Marion T. _Roper
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Sworn b ~nd wbscribad before ~e this ~ ~ dey of J~n~ 19 ~ i-.=:
. ROG~ ~OIT?AS - -
. C IT COt1RT Notary Pubp~ ~
d0~ ' ~9 ~Rr_.{ 5~~ ;
8y ~ D.C. My Commission expires
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; Ro b~ ~oacul~d ln dupikat~ and ai~inal Bi~d with qKlc qreuit Cour1, and dupliw~ witb Tax Aa~orJ ~
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