HomeMy WebLinkAbout0001 l'75226
Oeclaratton of Domicile a~d Citize~shfp
TO THE STATE AND COUNTY TAX ASSESSOR,
Si. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citize~ship in the State of Florids that I am filing this day in aoo~rdante ancl
in conformiy with Chapter 222, Section 222.17, Fforida Statutea. ~
1 was formerly a legal ~esident of COViI1¢tOt1 KenttcckX
(Ciy) (Stah)
and 1 resided at 562 Masorl Road . However I have changed my domicile
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida ~ince lOth ` day of
_~June ,~q
68, and I ~eside at 1002 Colonial Road
(Street and Number)
fORT PIERCE, SAIN? lUC1E COUNTY, KORIDA
and this statement is to fue taken as my declarotion of citizenship, actual legal residence and domicile in thR State of Ho~ida.
(Insert here any pertinent facts, such as sale of property or busi~eu, or relinquishment of employment
at former domicile, removal of family to ~ew domicile, pu~~ase of home, etc.)
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i'75a~
:,NO r~E~OftOE[~
~.uciE couNT r. ~
~ ~~CL~RD VERtF~~ ~ ~ .
~ 1969 F~~~~ ~1 ~ ~
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' :;.~RK CIP.CUi i COUit1 f
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I FURTHER CERTIFY that I will oomply with al) other ~equiremenri of a(epal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domiCile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FIORIDA, permanently. Q~
?VN~sv~ t/•
GORDON T. ROBTKER
~a~~ ~
1002 Colonial Road~ Ft. Pierce
(Address)
~ Sworn to and subx~ibed befo~e me this 28tl1 - dar of February , 19~L~.
`,t;s;~. ~ .
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ROGER POITRAS = ~ ` . y
. .
~ CIER! IRCUIT COURT ; ~ ~ , ~x ~ ••T`~:'~"°, v r , Notary Public
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gy ~ Q.C:_ : f' _ ~Ill~ ~ommiss'wn expires ~ 4
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(To b~ uacut~d in duplicab sirq fit~d. Eirwit Courf, ar+d duplicat~ wHi~ Tax A~s~or.)
Bc~K 11 ~ Pbc~~i~l .
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No. 13 "
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