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Declaration ot Domicfle and Citise~si~~p ;
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TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, F~oR~oA: 2~1~12
This is my declaration of Domicile and Citizenship in the State of Flo~ida that 1 am fiting this day in accordance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes.
- C e~e nnd
I was formerly a legal resident of _ . - - - -
~C~~y~ (State)
and 1 resided at _ 843~ ~est_ Cra1g____ - Howeve~ 1 have changed my domitile
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since _ 5tn _ day of
13ecember _ 19_7~, and I ~eside at 283 N. E. Saganore Terrace___
(Street and Number)
FORT PIERCE. SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
c
at former domicile, removal of family to new domicile, purchase of home, etc.)
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Roaanne Roaenberg 15 yenrs
Richard Rosenberg 14 ~esra
Gregory Roaenberg 12 yeara F~lEO ~ND aECORDEQ
St.lUC1E COUMTY FIA.
' ROGER POiTiI~S
; Susan Roaenberg 10 yeera CLERK Clr~u?r cou~tT
RFCORC YER~FIED...~..Li~%r
s Chriatopher Roaenberg 6 yeara ~ 3 ~ 41 pM ~7Z
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< I FURTHER CERTIFY that 1 will comply witfi all other requirements of a legal resident of this State.
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3 I FURTHER CERTIFY that I have no intention to retum to f rmer domic,ile, and I intend to remain in FORT
~ pIER~E, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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. ( me)
Doroth~ Roaenberg
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(Address)
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~ Swbrn to and subscribed before me this day of Januarv , 19~2.
ROGER POITRAS
CLERK CIRCUIT COURT Notary Public
.f:;;} By D.C. My Commission expires
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(To b~ ~x~cuMd in dupliuh snd oripinal ~iled with G~rk Grcuit Couii, and dupliwts with Tax Assessor.)
J` £ Nc. 13 A ~ "~Gi_
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