HomeMy WebLinkAbout0081 _ ~
OeClaratio~ ot Domicile a~d Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR, 151544
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Sl. LUCIE COUNTY~ FIORIDA: . •
This is my declaration of Oomicile and Citizenship in the State of Flaida thst 1 am filiny this dsy i~ aooords~os and
in conformity with Chapt~r 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of Cedar Rapids Iowa
Kity) . . . ~a»~
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and 1 resided at - 2~'0 - 28th Stieet Drive~ S.B. However 1 have cha~q~c! my don?icile
(Street and Number)
to and am and have besn a bona fide res'~dent of the State of Florida si~ce ~th day of .
Decamber , ~q 66, a~ 1 raside at 761 Sola2 Avenue ~ Pert St ~ L.ur_ is-, ~
_ (Street a~d Numb~)
FORT M~CE, SAINT tUC1E COUNTY, RORIOA
and this statement is to be taken as my declarotion of citizenship, actual legal residence and domidle in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to ~ew domiale, purchase of home, etc.)
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HOMSSTBAD PURPOSBS ~ ~ - : .
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• Ptl~~ !?ND REa p > '
~uci~ co~t~~~ ~ . .
$T~RECORfl VEa1F1~D
~ 151544 0
~61 JAM q 1~M ~ :4 -
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, ROGEa P4~7R 0~~
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! RIRTHER CERTIFY fhet 1 wili oomply with~all other requirernents of a I~al rssident of this State.
1 FURTHER CERTIFY that 1 have no intention to retum to my former domiCile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUfVTIf, FIORIDA, permanently. ~
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:.~~?+rr,, : r- - ~ ~ enry Hauseman r;
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{ V1T':; Cp,_~i~~,- ~ '
~ vrf~tV~'N~~ i~`"-
; T~, , : 761 Solaz Ave. Pt. St. L~~cie
~ : ; ~ • A; ~ (Address) Ft. Pierce ~ Fia.
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~~i ~q4i ~'~~'scribed before me this 4th day of Tanuarv ~q~.Z,
'j / _ iMti~~~ ~ ^4 ' I
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~ !Jt•::t:.•.:''.•~.:
. ROG~ 'OITRAS
~ CIRCUR RT Natary Public
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gy D.C. My Commission expires
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(To b~ ~c~aiNd tn dupticab and vri~nsl fil~d witb Cl~ek Cirwif Couii, snd dupliuh wiTh Tax As~or.)
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