HomeMy WebLinkAbout1910 Decfaration ot Domicite and Citisenship 9
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TO TNE STATE AND COUNTY TAX ASSESSOR,
Sl. lUClE COUNTY, FLORIDA:
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This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and i
~n conformity with Chapter 222, Section 2?2.?7, Florida Statutes. ~
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I was formerly a legal resident of _ Ch1CSg0 _ 28 I111IIO1S ~
(City) (State) ~
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10422 South Park Avenue
and 1 resided at _ _ _ _ _ _ _ _ . However I have changed my domitile ~
(Street and Number) _
to and am and have been a bona fide resident of the State of Florida since ____28 _ day of ~
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October 65 ~ 6411 S~ Indian River Drive :
- 19 and I reside at E
(Street and Number)
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FORT PIERCE, SAINT LUCIE COUNTY, FtORIDA ~
and this statement +s to be taken as m declaration of citizenshi actual I t
y p, egal residence and-domicile in the State of Florida. ~
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(I~sert here any pertinent facts, such as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to new domicile, purchase of home, etc.) ~
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AND RE~~R~EO
'FIL.ED~ ~ a00K ,
Establishing residence ~ -~r °
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MAR 3 ~ pM ~ ~ 3
- . t66 1~.~~~~~~~ERK 3
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- • ' ; - ST• FLpR10A ~
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I FUR7HER CERTIFY that I will comply with all other requirements of a legal resident of this State. !
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I FURTHER CERTIFY that I have no intention to return to my former domiSile, and 1 intend to remain in FORT i
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ' '
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_ t;. r ~ . . (Name)
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. Otis A. Rogers ;
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`r~ 3Worn 7o,end subscribed before me this 31 day of _~rCh }9 ff6
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ROGER POITRAS
CLERK CIR IT COURT Notary Pub(ic
ey D.C. My ~ommission expires
(To be executed in duplicste and original fiilsd with Clerk Grcuit Court, and duplicat~ with Tax Ass~ssor.) t
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aooK 142 106 ~
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