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Decla~atlon ot Oomicile and Citisenship ~
14'7501 `
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TO THE STATE AND COUNTY TAX ASSESSO ,
Si. LUCIE COUNTY, FLORIDA: -
This is my declarotion of Domicile and Citizenship in the State of Florida that 1 am filing this day in aotordante and
in to~formity with Chapter 222, Section 222.17, Floride Statutes.
Oresn B~ Wisconsin
I was formerly a legal resident of
(City) (State)
83? S.Jaakaon However 1 have cha m domitile
and 1 reaided at - - ^9ad Y
(Street and Number)
. - u
to and sm and have been a bona fide resident of the State of Flwida since - - day of
duue , 19 66 , and t ~eside at 2825 S• 4t,h Street
(Street and Number) ~
FORT PIERCE, SAIN? LUCtE COUNTY, RORIDA
and ihis statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Horida.
(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.)
Bntering Den iel BarteLas in llth t#rad~
N Beakis Bartelme in 9th Grad.e ~
p Boamie Ba~te].ae in~.9th (irads
FILEO AND ltEC~R~~O=
ST.RECORO VERIF
E0~
i G~e;~~ ~
~ '66 AUG 9 ~ ~01 Z
i 14'75
~ ROGER POITRAS ~
I CI.ERK CIftCU1T COURT ~
1
~
1 FURTHER CERTIFY that I wil) aomply with al) other requirements of a lega) resident of this State.
~ I fURTHER CERTIFY that 1 have no intention to retum to my former domicjle, and t intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_
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, ~ "T~,~•.'•~. (Name)
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. ..1, ~y , ,'r j~BI'~~II BaT'rr@Zfis
~ ms
~ ~ : . `t (Address)
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L. .
~ ' ~r `~liscribed before me this 9 da of , 19 ~ • ~
Swor . ~ a"~ Y
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ROCiER POITRAS
CLERK IRCUR COURT Notary Public
gy D.C. My Commission expires
(To b~ ~x~cut~d in dupliuts snd ori~inal filed with CM~Ic Grarit Cou~, snd duplicah with T~x Ass~stor.)
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