HomeMy WebLinkAbout0969 oec~arat~on ot Domicile and Citizenship 186~~~
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
1
This is my dectaration of Uomicile and Citizenship in the State of Florida that 1 am filing this day in accordance and ~
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in conformity with Chapter 222, Section 222.17, Florida Statutes. j
1 was formerly a legal resident of __Se?vatlll~th _ _ GEOrg1a
(C;ty~ (State) ~
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Rt 5 Box 407 ~
and I resided at _ - ~ - - - - - - - - - However I have changed my domiCile ~
(Street and Number)
to and am and have been a bona fide ~esident of the State of Florida since 28tb_____-_ day of ~
November_ _ , 19 69 , and I reside at~C Mobile Hon1t Court ~
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida. ~
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of famiiy to ~ew domicile, purchase of home, etc.)
Mr Coleman is wita the Potashnick Dredging Co and working
~II~ED AtJD R~CORDEO
~ I CQUP'TY FL' . ;
- Lt, G E ~ "
here- ~ .,fF~~'=C ~
18628`~ ;
Bntering the children in school ~
'~9 I A~1 9 : ~9 ~ ~
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C~_R~ :lR~~~lT ~~JURT
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' I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
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~ 1 FURTHER CERTIFY that 1 have no intention to return to my former domi~ile, and i intend to remain in FORT
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~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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~ . - ' ' /~~~~,n~
~ . (Name)
- - 1Kelrose Coleman C Mrs. James )
~ . . ~ . . -
_ ~ - . (Address) ;
~ 1
ir ~ ~ December 14 69 ~
= ,S~IVtrrh't0 ~and subscribed before me this lst day of , -
i
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ROGER POITRAS
LERK CIRCUIT COURT Notary Public ~
f^~
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` B D.C. My Commission expires
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(To b~ sxecuhd in dupliute and originsl filsd witfi Gerk Circuit Cou~, and duplicats with Tax A:s~ssor.) ~
~ BOOK~~~ PACE
g~ No. 13 • ~
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