HomeMy WebLinkAbout1123 143633~
Declaration ot Domicile and Citizenship
TO THE STATE ANO COUNTY TAX ASSESSOR.
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Oomicile and Citizenship in the State of Flo~ida that 1 am filing this day in attordante and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _ VERO BEACH ~IA .
(City) (State)
1235 2~th St.
and I resided at - Howeve? I have changed my domi~ile
(Sireet and Number)
14th
to and am a~d have been a bona fide resident of the State of Florida since day of
- Jan. S? Star Route--Jensen Beach
, 19 and I reside at
(Street and Number)-
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declarotion of citizenship, actual legal residence and domicile in the State of Ho~ida.
(Insert here any pertin~nt fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
F IL t NG FOR HOINBSfSAD PURFOSBS
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r-~ ~~-~-.°~i~,.~ r FI~E ~ AND REC RDED
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R~ST. LUCIE COUNTYRK ~
Fl.OR1DA
1 FURTHER CERTIFY that 1 will aomply with alf other requirements of a legal resident of thia State.
I FURTHER CERTIFY that I have no intention to return to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCtE COUNTY, FLORIDA, permanently.
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. • (Name) -
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~ ROLAND D . MI~OODRUPF
~ ` ~ - - (Address)
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~ Sworp~~nii subscribed before me this 17th day of '~rch , 19~6.
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~ . • ~C~GER POITRAS
q~RK UIT COURT Notary Public
By D.C. My ~ommission expires
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~ (To b~ in duplicat~ and oripinal Al~d wHh Cl~rlc Cirwh Court, and duplicat~ w~1h Tax Ats~or.)
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