HomeMy WebLinkAbout1143 Declaration ot Domicile s~d Citizenship
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'f0 TME STATE AND COUNTY TAX ASSESSOR,
Sl. IUCtE COUNTY, FLORIDA: ~
1'his is my declaration of Domicile and Citizenship in the State of Floride that I am filing this day in accordance and
in cnnformity with Chapter 22~, Section 222.17, Florida Statutes.
I was formerfy a legal resident of MtltdOa~i Z~.11Q0~S
- - tCiry) _ _ _ - _ ~State)
N 1~8~l~iI1 StleQt However I have cha~ ed m domicrile
and I resided at - - _ - - _ 9 Y
(Street and Number)
3
to and am and have been a bana fide resident of the State of Florida since _ day of
Augnst _ ~q_b~ and I reside ar _ S 33rd Street, A.A.Green
~ ~ (Street and Number)
FORT i'iERCE, SAlNT LUCIE COUNtY, ~LORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residente and domicile in the State of ~Idrida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishmPnt of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Bntering children in school
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l~ ~ RE ~R@Ep
~DOK
~ss AUG ! 6 I I: 23
ROS~ t; F~:~,~-i-- ~ u~~
: •~t~;~--:~. ~~C~EtCOUNTERK
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. FLOR~p Y•
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t FURYHER CERTIFY that I wili comply with all ott~er requirements of a lega) resident of this State.
I FURTHER CERTIFY !hat I have no intention to return to my former domi~ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, rLORIDA, permanently.
' " ' ~ l% ~ - - -
, (Name)
,~~,~~~'i;=.~•~~'s,
~ ~ra' y.' _ LOttiC Tindell
~ - a' ` - ' ~ ' ' (Address)
_
. _ , ~ :
w~•'~+~ :~i;
v ~ 1 S,1Vp~tJtr ~d s~bscr~bed before me this ~b day of Au ~a~~-_---__ , 19~lS._.
ROGER POITRAS -
CLERK CI iT COUQT l~iatary Public
g ~ D.C. My Commission expires
Y
{To b~ exscuted in duplicate anc3 ariginal ~iled with Cferk Circuit Court, and duplicate with 1'sx Ass~ssor.)
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