HomeMy WebLinkAbout2419 ~.63p'7g
Declaratio~ ot Don~icile a~d Citize~ship
TO THE STATE AND COUNTY TAX ASSESSOR,
51. IUCIE ~OUNTY, FLORIDA:
This is my declaration of Domicile and Citizer~ship in the State of Florida that 1 am filing this day i~ ataordante and
~n confo~mity with Chapter 222. Section 222.17. Florida Statutes.
1 was formerly a legal resi~ent of ~INB WISC. _
~C;ty~ (Staro)
and 1 resided at ~ 6900_DuiSnd Avt. ~WeVef t have changed my domicile
(St~eet and Number) ~
ro and am and have been a bona fide resident of the State of Florida since __~6th _ day of ~
;
December 67 2501 iY. Federal Highwaq-Box 26 ~
- - - - - . 19 and I reside at ~
(Street and Number)
~
FORT PIERGE, SAINT LUCIE COUNTY, RORIDA .
and this statement is to be taken as my declaratio~ of citizenship, actua) legal residence and domicile in the State of Horida. ;
(Insert here any pertinent facts, such as sale of propery or business, or reli~quishment of employment
at former domicile, remova{ of family to new domicile, purchase of home, etc.)
ESTABLISHING RESIDENCB
FILED ~NO RECORDED ~
ST. LUCIE COUNTY. FLA. ~
RECORD VERIFIED
i
~ - '6~ DEC 29 AM 9: S9
1f?30`?'$
riO:~~R =~OITR:.S
CLERK CIRCU{T COURT
~ ~
1 RlRTHER CERTIFY that I will oomply with all other requiremenft of a legal resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTIf, FLORIDA, permanently.
_ ~~y`...'~
~ •
. BARL R.~~~BRIKSEN ~
~ • ~
• -v~~" , . I.ILLIAN ~~:e~~~
= ~ . ~ ' FRBUERIKSBN
; .:,t F =
: _
' ' " - Y = 29th ~ Decewber , 19 67
t S~i~1 ~to ~n~"tubs~ribcd before me this day of - -
- : ~ , ! '
. • •~i/ ti-
i'-._--~:_ Y:
,
COURT . Notary Public - -
~
gy G.C. My ~ommission expires
(To b~ i~ dupliesb and oripinal fil~d wilh Cl~rh preuk Co~r~, and dWelie~t~ will~ Tax A~ssor.)
g~1~ ~~z4a1
, s . . - - - - -