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Declaration ot Domiclle and Citizenship ;
159208
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIDA: ~ ~
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This is my declaration of Oomicile and Citizenship in the State of Florida that 1 am filinq this day i~ aooordanoe and i
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~n conformity with Chapter 222, Section 222.17, Flo~ida Statutes. ' ~ j
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I was formerly a legal resident of ~keVillA Ke11tuC14t ~
(City) (Stats) #
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?12 Cline S~ti~eet . However 1 have cha m dcmiti~e ~
and 1 ~esided at - _ - - y E
(Sireet and Number) i
2 da of ~
to and am and have been a bona fide resident of the Stats of Florida sinee 3 Y ~
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Januaiy 67 ~i~da Hobile Hanes ;
. 19 , and I ~eside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA ~ ~
and this statement is to be taken as my declaration of citizenship, actusl leyal ~esidence and domicile in the State of Horida. ;
(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of employm~nt
at forme~ domicife, remova! of family to new domicile, purchase of home, ett.)
~nter ~_ng two child ren iu ~esnentary School
Tamera Dj.xson in Ist Grade ST AN~ R ~
Greg Bridgers in 2nd Crade ' ~
u ~UNTY F~q, ~
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I ~L~RK CIRCUIr CO
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I FURTHER CERTIFY that I will oomply with all other raquirements of e le~al resident of this State. ~
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I FURTHER CERTIFY that I have no intention to ~eturn to my former domic.ile, and I intend to remain in FORT -
PIERCE, SAINT LUCIE COUNTY, FLORIDA,.permanently.
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~ r. ~ ~irley uixan
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.~Vpipt3~b tsubxribed before me this 17 day of ~uBust ~ ~q6~_,
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ROGER POITRAS
CLERK CI CUR COURT Notary Public
~ gy D.C. My Commission expires
(To b~ ~x~nrl~d 1n duplieat~ and ori~nsl fil~e! wHh Cl~rlc Cirwit Ca+r1, and duplieat~ wilh Tax Ast~orJ .
e~oK~b~ P~t~~~
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