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Declsration ot Domicile a~d Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, ?
1
Si. lUC1E COUNTY, FIORIDA:
This is my declarotion of Oomicite a~d Citizenship in the Stats of Florida that ! am filing this day in aooordanos and
in oonfwmity with Chapter 222, Section ?22.17, Florida Statutes.
1 was forme~ly a legal resident of Indiaaapolia lad.
(Ciy) (Staro)
and 1 resided at 1137 ~iMSO~ _ . Flov,rever 1 have cha~ged my domic~te ~
(Street and Number)
to and am and have been a bona fide resident of the State of Florida sinee ~q ls day ot
, i9.~q , a~d i~~~de at 805 Azales Dr3~e
(St~eet and Number)
FORT PlERCE„ SAlNT LUCIE COUNTY, ~LORIDA
and this statement is to be taken as my declaration of citizenship, actual lega( residence and domicite in the Stab of Horida.
(tnsert here any pertinent facts, such as saie of property or business, or relinquishment of employment
at former domicile, removal of famity to new domicile, purchase of home, etc.)
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Yictoria Mn Ynight ~
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Batablishing reaidence and placing cbild in public school
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FILED AND RECORDED xo ~ ~cp
ST, LUCIE COUNTY, FL:., cir~*~i ~mn
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CLf RK~C RCUt i COURT
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1 FURTHER CERTIFY that 1 wil) oomply with all othe~ requirements of a leqa( resident of this State.
1 FURTHER CERTIFY that 1 have no intention to return to my former domitjle, and I intend to remain in FORT ~
PIERCE, SAINT LUCiE COUNTY, FtORIDA, permanently.
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~1~~ti~s! subscribed before me this day of ~ ~q
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~RK~ ~UR CO Notary Pubtic
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BY,,;,~}; D.C. My Commiuion expires
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(~o b~ ,ix~nM~d i~ du cah and
Pli ori~ieal AMd Mritb Cl~rk Cisnrif Court, aed d~litafr wi1M Taoc As»t~or.)
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