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Decla~ation ot Domicii~ ar~d Citis~nship ,17?4255 ~
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TO THE STATE AND COUNTY TAX ASSESSOR,
ST. lUC1E COUNTY, FIORIDA:
This is my decla~ation of Oomicils and Citizenship 1n tha Staro of Horida Mat 1 am filiny this day in aooo~dante and
in oonformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a lagal resident of Philadelahia. ~pn yl vania
(Ciy) (Staro)
and 1 resided at 26S S.~ma~ StrrsRt . Fbwever I have thanyed my domidk
(Street and Number)
to and am and have been a bo~a fide rosident of.the State of Florida sinae 1rs~, ~Y ~ !
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T~nLarv _ , 19~1~, and 1 ~A3ide at Star Rnu~~ Snuth TN~an Biver Drivo '
Jensen Beach~~b~@lumber) ~
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roRT sru~ wc~ cou~nr, aow~~ ~
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and this statement is ro be taken as my declaration of citiunship, actvat legal residenos and domiale in ths State of Horida. ~
(Insert here anY pe~tinent facfs, such as sale of properiy or business, or relinquishment of employment l
at former domicile, removal of family to new domicile, purchase of home, etc.)
Purehased property and built home on following described property:
The Southeasterly 110T of the northwesterly 540' of r
the easterly 100' of the wester~y 583.9' of Clearview ~~~~EO AND R~COROE~?
Subdivision as reeorded in Plat Book l, at Page 204, ST. LUCIE COUNTY. l~~p,'~
of the publie reeords of St. Lucie County, Florida; and RECORp YERIFlED '
also that part of the Southeasterly 30 feet of the North- ~~4255 ~
westerly 600' of said Clearview Subdivision lying ~r Za ~
of South Indian River Drive less the westerl 483. ' ~
and the southeasterly 30 feet of the northwesterly 570 S~/~
feet of the easterly 30 feet of the westerly 513.9 feet,ROGER ITRAS
the above pareel being parallel with the north and we~~ERK CIR UIT COURT_'
lines of said Clearview Subdivision.
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~ I FURTHER CERTtFY that 1 will register at my local addreu when the registration books reopen, and aomply with
~ all other require~nts of a legal resident of this State. -
I FURTHER CERTIFlf that 1 have no intention to retum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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, ~ tn,ame) f
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~ Star Route, South Indian RiverDrive,
~ ~~eu~Jensen Beach, Florida
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Swom to and subscribsd before me this 28th. ~y ~ Januarv ~ , 19~_.
,`~r" ,
ROGER rO1TRAS
C~ERK CIRCINT COtIRT . ~ Notary Public
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