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Declaration ot Dor~icile a~d Citizenship
TO THE STATE AND COUNTY TAX A55ESSUR,
Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Uomicile and Citizenship in the State of Florida that I am filing this day in actordance and
in confarmiry with Chapter 222, Section 222.17, Florida 5tatutes.
I was formerly a legal res+dent of Da.X~QA----.--- nhin
(C~ty) (5tate)
and 1 resided at _ 255 SQ Findl~~?__S.~~g,~~_ . However I have changed mv damiGile
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ 1St _ day of
Augus! 19_ 65 a„d i reside at ___lOO EBtOA drive z-Port St.Lucie
-
(Street and Number)
FORT PIERCE, SAINT LUCIE tOUNTY, FLORIDA
and this statement is to be taken as my ~eclaration of citizenship, actual legal residence and domicile in the State of Flarida.
(Insert here any perTinent facts, such as sale of property or business, nr relinquishment of employment
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
Establishing residence
Np RE~OR gp OK
F~LE .
IN__ ~k%~u" ::~r~c~«,~,
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G~l_..~,:~SUN~YR
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I FURThlER CERTIFY that 1 wil! comply with all other requiremenis of a legal resident of this State.
i FURTHER CER7IFY that I have no intention to return to my former dorr~i4ile, and I int~nd so remain in ~ORT
PIERCE, SAINT LUCIE C~JUNTY, FLORIDA, ~ermanentiy.
~
, -
; ; X-- -
`~=f (Name)
~ ~ . ` Bdwtrd S Bisch
~ ' , ' - Address) ~
. - . (
, . ...•.ry . .
~ ` " ~ 18th October 65
~'Swarr~ to and subscribed befare me this ~ day af - , 19 -
ROGER POITltAS
G CIRCUlT C URT Notary Public
~ i ' n ex ires _
~p---~ _ D.C. My Comm ssia p
(To b~ ~xecuted in duplicatr snd origina) ~iled witfi Clerk Circuit Court, and duplisatl? with t~x Assrrssor.)
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