HomeMy WebLinkAbout0687Declaration of Domicile and Citlzenshlp .18159Q
TO THE STATE AND COUNTY TAX ASSESSOR,
Sj. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in stoordanoe and
in conformity with Chapter 222, Settion 222.17, Florida Statutes.
I was formerly a legal resident of COrj/dOn
(City)
and 1 resided at _ Rt 2 BOx ••
(Street and Number)
Ind.
(State)
However I have changed my domicile
to and am and have been a bona fide resident of the State of Florida since 6th day of
August , 19 69 and I reside at Rt Z Box 3300 Lakerood Pint
(Street and Number)
i'ORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Honda.
(Insert 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.)
Bstabiishing residence
Entering s Dana in the 2nd grade
INichell in the 3rd grade
Tracy in the 4th grade
FILEp ANO RE 8i58D
ST, IUCIE CpUNtY F ~_
RECORD VERIFtEp~A.•
'69 AUG 8 AM 9 ; ~ 0
ELERK. CIRCUIT COURT'
1 FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this Stata.
I FURTHER CERTIFY that I have no intention b return to my former domicile, and 1 intend to remain in FORT
. m .-
PIERCE, SAIN~IIiIC,~ jCfiUi~TY, FLORIDA, permanently.
:. ,,.; , ~ ; .. ~. .. y
..~•--
_~~;; ~,, ~o ' ~:. s (Name)
_ - `_
~_f.~j~ ~-', ~t~ = Phillip Timberlake
.-
~~~~ ~ J....•GO., . - ~ (Address)
Sworn to and subscribed before me this
ROGER PORRAS
CIRCU COURT
t3 d~-~'L D.C.
ath day of August
Notary Public
My Commission expires -
(To Ibo executed in duplieab and original filed with Cleric Cirwit Court, and duplicate wHh Tsx Assessor.)
-~. , ~ ~o>(~79 ~~ 686
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~_~__ _
19 69.
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