HomeMy WebLinkAbout2454 Declaration ot Domi~ile a~d Citisenship
TO THE STATE At~~D COUNTY TAX ASSESSOR, ~~,2161
~i LUCIE COUNTY, FIORIDA
Th~s ~s my declarat~on of Domicife and Gtizenship in the State of Florida that ~ am fil~ng this day in accorda~ce and
n conformity w~th Chapter 222, Sect~on 22?.17, Florida Statutes
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I was formerly a legal resident of I'•_ I~. _ _ -Nep_ YO
~~;~y~ (State)
and 1 resided at T.OY2$ B@8C~ _ However I have changed my domicjle r
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(Street and Number) ;
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~o and am and have been a bona fide resident of the State of Florida since October 5 day of ~
7/ ~
Route 4 poa ~ 41 Ed~srds__Road
, 19_ and I reside at _ _ . . _ - - - ~
Fort Fierce~t Floruida~~ ~
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FORT PIERCE, SAINT LUCIE COUNTY, FtORIDA
and this statement ~s to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(lnsert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
HoEeatead and eatablishing residency
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F LED ~t+[ ==_G:;R~EO
Lt?Csi ::,t'MTr FIA.
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~ ~AM I~I ~ DO ~M'7Z ~
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Y I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State. ~
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~ I FURTHER CE~2TIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT tUC1E COUNTY, FLORIDA, permanently.
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: f (Name)
Robert Roth
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Swom to and subscribed before me this day of . 19~
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ROGER POITRAS
_ CLERK CIRCUIT COURT Notary Pubfic
` ~ ' 1 a D.C. My Commission expires ~
~:u3 aY - ~ - -
° (To be exscuted in duplicate snd original filsd with Ckrk Grcuit Court, and duplicsts with Tax Assessor.)
198 P~; 2451
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