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Declaration ot Domicile and Citizenship
TO THE STATE AN~ COUNTY TAX ASSESSOR,
51. IUCIE GOUNTY, FIORIDA:
This is my deciaration of Oomicile and Citisenship in the State of Florida that I am fili~g this day in aooordance and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was forme~ly a legal res~de~t of Franklin Wisconsin _
(City) (Stsb)
and 1 resided at _ 3220 West Puet Z Road _ . However 1 have chanyed my domici~e
(Street and Number)
to and am and have been a bona fide resident of the State of Flotida since 9th day of
_ .MaK. , 1968 , and I reside at 1625 So. 4th Strtet
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Fbrida.
(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.)
to establish citizenship in the State of Florida
FILEO AND RECORDED'
ST. ~UCIE COUNTY. FLA.
R~ C('~'~ 4~~'L
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'68 MAY I0 ANI 10: I6
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CLERK CIRCUIT COURT
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1 FURTHER CE~tTIFY that I will comply with all other requirements of a le~al resident of this State.
I FURTHER CERTIFY that I have no intention to refum to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, fLORIDA, permanently.
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(Name) Otto Bauch
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~ 1625 So. 4th St reet
~ (Address)
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~ _ 4 •,,.~Swqt~~ a~d .:ubscribed before me this 10 day of ~ Y , 19 6 8
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N' °s. ;
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~ •r ,~4~' ~QITRAS
p,~l( e1RCWf C ~ Notary Public
g ~ D.C. My Commission expi~es
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Q~ b~ ~x~crl~d M d~rplicah aad ori~iwal tiNd wilh Cl~ek Ci~N Co~M, and d~pNcaN wilb Ta~c A~~J
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