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Meu-tha Pi tlinq
~T. tUCI[ COIH{';Y. FLA.
Declaration of Domicile and Citizenship
TO TIlE STATe AND COUNTY TAX ASSESSOR,
ST. UXIE COUNTY, FLORIDA:
Thia iJJ my deel&.ratioD of Domicile allld CitizeMhip in the State d Florida that! am filing this day in
accordance, and in ccnformity with Chapter 222, Section 222.11. Florida Statutes.
, . NEW YO~ CITY NEW YORK
I was formerly a leial resident of,_..._..'no__'...__..__mm__'...___n__.'_._____'_.u__'______'' ....._,._____...__.____....____'.n.._.__
~tf) (State)
and r resided at ,7 ,J.Y.>g~__.P.1..~!?~,L~~,~~,~~~_~~, __, ~~ }s.l~ever. I have changed my domicile
(Street aDd Number)
to and am and have been a bona fide resident of the State of Florida since., 17th .' ,..', day of
_......___,uo.D,._c.embex,--...,..,-.--..... 19.6.0.... and I regide ut6Ql_..M,a.l,~~__A,..~I\~~.,-"-.-.---..,--.----n--....,,--'m..---
(Stnet and Numt>.r)
'.._00. __....._...,___X~I:\:___P~~r,Q~L _.. __________mn__n" ___.__,~t! __ L~~.t~_m'__...__._ _m"".'" n _____m__ County. Florida,
(City )
and this statement is to be taken as my d€claration of citizenship, ~ctual legsl residenC'-e and domicile in
the State of Florida. "
(lMert here any pertinent bets, IUch u ni. of property or buaineu. or relinQu~hment of emploTIOmt at
former domicile, removal of family to ""w domicile. purehul of home, .tc.)
93085
FILE NO PI ORDEO
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1%\ ;1nR I 3 A~i 10: 1 9
ROGER POITRAS, CLERK
S 1. L U C I E S Q',PH Y. F L 0 t\ : D A
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I FURTHEh CERTIFY ~at I will register at my local addreM when the regi8tration b)On reopen,
and comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to retum to my former domicile, and I intfnd to remain
in.-__.____~~!~.!_i.roe ._-.,---, St. ~a.o~~_.._n_____.-_n-_...._._County. Florida,
pemwtently. <_I ~~_~~___..
Martha FittinQ cJ'
----.(Ad4resI) -.-- ._.___n_____._
(To be exeeuted 1D duJ;Jieat. aDd oriaiD&l 61ed wttl a.rk ~ ('.OQri. 'ud dQlleate 1Irith 'I'&x A~taOt)
Ro_ ....h. C... Pint CUr, na.