HomeMy WebLinkAbout1421 _ D~cluatio~
ot Dornic~l. ar~d cltur.~shlp .~5442g
TO THE STATE AND COUNTY TAX ASSESSOR.
Si. LUClE COUNTY, FlOR1DA: ~
This my deciaration of Domicils anc! Cltiz~ruhip in th~ Stat~ of Florida that 1 am flllnp thi: day in aooordano~ a~d
in conformity with Chepter 222. Sectian 2?2.17. Horida Statutes.
~ was tormarly • Iege1 residMr of _ Hillaborough New Hampshire
~CitY) tStah) .
end 1 rosidsd at Rt' ~ . How~vK 1 haw dur?q~c! my domkii~
~ (Stnit and Number)
ro and am and have been a bona fide ro:id~nt of tM Stata of florida :inoe lst ~y ~
: July , 1966 ~ s~' ~ Rt. 4 Box ~44 DaAiels St. ~
- - - (StrMt and Numb~r) .
fORt MI~C~, iA1NT lYC1E COUNTY. lLORIDA .
and this :tatement is ro bs tak~n es my dedaretion of dti~nship, actual le~al re~ideno~ a~d domidls in the Stst+~ of Hortda.
pnsert here any pertinent facts, wch as :als of property or busineu, or relinqui~n+~nt of ~mploym~nt
at former dar+idis, rentioval of family ro new domiale, peirchast of home, etc.)
P ILING FOR HO~IBSTBAD pURFOSBS
FIIED AND RECOROEO .
" ST, LUCIE COUN~Y. FL.A.
~ RECORD VERtFtEO
-La~~
'6T I~AR 31 PN I :04
~ ~o~EP ro~TRaS -
CLERK CIRCUtT COURT
1 fURTHER CgtT(FY tbst 1 will oomply w(fh ali afF~ nquinrr~ents o~ ~ lepal rosident of this Sts~t.
~ ' I FURTHER CERTIFY that I have no intention ro mfum to my former domicjle, and i intend b remain in FORT
~
PIERCE, SJ?INT lUCIE COUNTY, RORIDA, permanently. -
- .:~s: e -
. . . ~
~ tName)
~~:?+:~iu~1»~;lf~•. ~;r;
:'2,GV
N:-~.~OG~~,,~~ JAMBS C. ROGERS, JR.
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- S', c D = 'X,' -~h ' W~+d ~
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: ;Y 1
~
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. wbsuibed before me this 31 day ~ MarCh , 19 .
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•
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. ~ ` . Notary Publk
BY , D.C. My Gommiss~n expiret
- R~ b~ ~ac~e~i iA duplie.ti aa~l ~eiaiw.l fiMd wNl~ Ct«~k CinaiN Cwe1, and d~plkaN wi1~ Taoc A~~J
d00il~~ PACE~~B
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