HomeMy WebLinkAbout0112 ~eciaratlon ~t Domicit~ a~d Cltls~nahip .~6159,7
Tp THE STATE AND (.1?UNTY TAX ASSESS(:R.
S1. IUCtE COUNTY, FLORIOA:
This is ~ny declaration of Domicile and Citi:enship in the Stat~ of Florids Mat I sm filin~ ~'h~s day in acoo~ana and
in oonformily with Ghapte? 222, Settio~ 222.17. Florida Stafutes.
Wisconsin
1 was forme~iy a legal resident ~p=~
(City) ISteh)
and I rosided at _ Rt 1 1~~ my domk3le
(St~~st end Numb~r)
b and am and have been a bona fide resident of the Stste of Florids sinoe 8th ~y ~
Noveaber _ , 19 6? , snd I ~eside at 32~1 So Federal Hi-xay
(Street and Number)
FORT M~CE, SAINT LUCIE COUNTr, R~A
and this statement is to be tsken as my declaration of citizenship, actual leyal residence end domidls 1n the State of Horida.
(Inse~t here any pertinenf facts, such as ~le of propery or business, or relirtqui~+ment of employmsnt
st former aomicile, removal of family to new domitile, purchase of ~iome, etc.)
,
:s
ante.ring child in the 4th grade
~~~ED ANO RECORDED ~
' - S?. lUC1E ^ VERIFIED ~ -
R._coR:. ~s159'~'
'6T K(~V 9 ~ ~Q ' ~y
~ ~
- z ~o~Ta~s '
iiG~'vL
CLERK GIRCUIT COUR7
;
t
1 fURTHER CHtTIFY that 1 wiil oomply with all otfier rsqui~smsnts of a lepal resident of this Sfats. ~
- t
,
1 fURTHER CERTIFY that I hav'i~no intentior~ to retum to my forme~ domiGle, and I i~tend to ~emain in FORT
PIERCE, 5~,(~;T,~4iC1E COUNTY, FIORIDA, permanently.
,'.i.;~ -'i
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_ . : c~;. _ (Name)
~'7! : °1.;~; , Flor~ine Haedt ( blrs I.ouia ~
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.
. _ I. ` G;; : . J ~ • . 0~~ ~
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.,Sworn b and subscribed befor~ me this 9th ~y of November , 19 ~7 . ~
RO~iER rOITRAS
~IRCWT Cp1lRT Notary Public
gy ~ ~~y~~ D.C. My ~ommiss'ron expires
(T~ tw a~aaMrd in d~ptical~ a~ ai~iw~l ~d wilb Ci~t~ Ci~aih C•ew4, and dvplicaN will~ Tax A~~J
s~K16~ ~ 1~ ~4 ~ .
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