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ST. lUC1E COUNT'~• FE~• Cherlea Bauens
Declaration of Domicile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR,
ST . LIIC IE COUNTY. FIARID.lI.:
This is my declaration of Domicile and GYtisenahip in the State of Florida that I am !fling thin day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
NEW TORK
I was formerly a legal resident of-----------asT---------------------------------, -------- --------------------------
(Cita? tSrt.I
and I resided at- 843 -_-;7lLxt__~~A------------------------ -_ - - - ric~wover, i ru-va c.,,ws", mr u.,.,,..,....
(Street sad Number)
to and am and have been a bona fide resident of the State of Florida since _- -°3~at _-__------ ----------.day of
September-------------------------------, 19-_-80 and I reside at------2009--~-*---51st _St. ------- ------------- --------------
(Street and Nvmber)
Fort Pierce - --_-- -------____-, 3t. Luc ie -- --------------- ---_-- -- __---County, Florida,
------------------------------------ ------------- - -
(ati~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in
the State of Florida. ~r y
former domicilarr mo~alnol lamil7 to new~domidle.oD rehaa os bomt.o~r~lingvLhmoat of omDloymoat at
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ROGER, P~?I -'"S, ~LCRK ~~
I FURTHER CERTIFY that I will register at my local address when the registration hooka reopen,
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and comply with all other requirements of a legal reaaei,t 8i ~..~ ~~~~•
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain
Fort Pie r.: e --------------- - --------- St-~--Lucie-------county, Florida,
(c~til
permanently. ~ __Q
-~~------ --- ---dL~~`--'1'"~----------------
~-- ~ l~'~- (Name)
Charles Beuene
------ ----- --------------
(Addres~)
Sworn to and subscribed before me ~thia.l4 th--may of
.,.,....,, ~.M.'
---------- l~sb~u~~ _:~'- --_-___,-A. D. 19.61 _.
_ ~~ ~ ~!?lY~ -
- --- --~~otaff ~ab~3e Florida at Lrse
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My Commis~ior~.~P~--=-~/Z~-~83--------------
.,
(To be ytoanted-~A'.dlipdd~fd~!!?~d original bled with Clerk 'C'ircuit Covrt, sad duplicate with Taz Assessor)
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Kc.Hrn tiupp~y t'n, P1aAl~V1{~~.1T1!•'• .