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~ Decl~ration ot Don~iciie and Citis~nship ~
- . 151489
TO THE STATE AND COUNTY TAX ASSESSOR, ~
. ~
Si. LUCIE COUNTY, FlORI~A: • ~
This.i~aay deciaration of Oomicile a~d Citi=enship in the State of Flaida thst 1 am filirp thi: day in aooorde~a and
in ooaformity with Chapter 222, Section 222.17, Flo~ida Statutes. -l
I was fo~merly a legel ~esident of .~Y~
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and 1 resided at P• O. Bo~c 91 . Fiowevaf 1 have chanyad my domicjle
(Street and Number) . ~
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to and am and have been a bona fide resident of the State of Florida since day of
.18nt~tsz~y , ~9¢? , and ~ roside at 716 S. lOLh St. -
(Strset and Number)
PORT MERCE, SAINT IUCiE COUNTY, FLORIDA _ ~ ~ ~
and this statement is to be taken as my declaration of citizenship, actuai iegal residenoe and domicile in the State_of-Florida.
pnsert here any pertinent facts, such as sale of properry or business, or relinquishment of employment
at fcrme~ domicila, nemoval of family to new domicile, purchase of home, etc.)
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ROGER $~4$~
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1 FURTHER GERTIFY that 1 will oomply with all other requiraments of a leyal reaident of this State.
; I FURTHER CERTIFY that 1 have no intention to return to my former domic~le, and t intend to remain in FOitT
_ PIERCE, SAINT LUClE COUNTY, FLORIDA, permanently.
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'_~-a%~-~: ~pr~~q,~~~bscribed before me this ~ day of J~~~ J ~9b7 ,
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, ,~K' CU RT Notary Public
gy D.C. ~ My Gommiuion expires
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- lTo b~ ~c~cuhd dvplicai~ snd ori~insl fil~d with G~rk Circuit Couif, and dupli~st~ witf~ Tax Ass~ssor.)
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