HomeMy WebLinkAbout0537 Declaratio~ ot Domicile and Citizenship ~ ~
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TO THE STATE AN~ COUNTY TAX ASSESSOR,
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Sl. lUC1E COUNTY, FIORIDA: !
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This is my declaration of Domicile and ~iti=e~ship in the State of Florida that 1 am filing this day in accordance and ~
in conformity with Chapter 222, Section 222.17, Florida Statutes. f
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I was formerly a legal resident of _ Racine Wisconsin _ ~
~~;~y~ (State)
and 1 resided at 626 Arthur Ave ~„Ve~er I hsve changed my domitile
(Street and Numbe~)
to and am and have been a bona fide resident of the State of Florida since -________2~L day of
August 66 114 West pri?~.a Vieta Blvd,
, 19 and I reside at d Number)
Port St.~~~L~'
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this stateme~t is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Horida. f
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence
FIIED ANO RECORQE~
ST. LUCIE COUNTY• r~•
RECO~~'
• 3
'~6 1~~~~ 30 P~~i . 0
148~'
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' CLERK CIRCUIT ~fl~RT
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1 FURTHER CERTIFY that 1 wil) oomply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intent~on to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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' • " " (Name)
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. ~s ~ r ~ Brnest W. Ziebeli
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Swofn~tts ~Ad subscribed before me this 30 day of AuguSt ~ 19 66
ROGER POITRAS
K CIRC IT COUR Notary Public
gy ~ D.C. My Commission expires
(To b~ ~xecutsd in dupliuts a~d ori~insl ~iled witl~ Gerk Grcuit Court, snd dupliuN wilh Tax Ass~ssor.)
aoo~ 153 537
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