HomeMy WebLinkAbout1099 Declaratio~ ot Domicile and Citizenshlp
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj. IUCIE ~OUNTY, FLORIDA: `
This is my deciaration of Damicile and Citizenship in the Stats of Flo~ida that 1 am filing this day in aooo~dante and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ~St00 H!M YOr~ ~
(City) (Staro)
and 1 residad at _8539 BOStOt! St4t! ROi~d .~,Never ~ heve changed my domici~e
, (Street and Numbe~)
to and am and have been a bona fide ~esident of the State of ~lorida since -~C.t.T4 day of
~ , t9 69 , and 1 res'~de at 762 Ox~[ Strelt
(Streat and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taRen as my declaration of citizenship, actual legal residenca and donnitile in fhe State of Horida.
pnsert here any pertinent facts, such as sale of property or busineu, or ~elinquishmant of employment
at former domicile, removal of family to new domicile, purchase of homs, ett.)
Sstsbiiabing residency snd placiag san in pubiic school
~Gary Roberta)
FILED AND RECORDED
ST, LUCI~ COUNTY F
rir Ct7?~^ ; LA.
~ {FIED
'69 OCt 10 i22
AM Ip : p0
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; .,c ~ ~:t ~~c~~ ~ F~,s
~ CL~RK C;RCUIY COURT
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1 FURTHER CERTIFY that I will oomply with all other requirement: af s leyal resident of this State.
i FURTHER CERTIFY that I have no intention to retum to my former domicjle, and I intend to ramain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
?
tN e~ Roy J Roberts
~
. (Address)
, ; s `~L.~;' . . .
- - ,
• • . •
T Swor~~tq'and_subsuibed before me this s~ day of ~~~s , 19~~.
' ~RO~R:.PO1fItAS - -
~ ;~UIT COURT iVotary Public
"%ii. ',~:~.z. ' .
By ~ D.C. My Commiuion expires
(To b~ uc~cubd in duplicah and ori~ina{ fil~d wi1i~ CINIc pra~if Court, and dupliut~ wbh Tax At~aror.)
~ooK180 ~~0~6
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