HomeMy WebLinkAbout0078 . ~ _ - _ _
Declaration ot Domicile and Citisenship
16~3"~'t,~
TO THE STATE ANO COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORIDA: ~
Thiti is my declaration of Domicile and CitiZenship in the State of Florida that I am filiny this day in aao~rdanoe and
~n aonformity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of Hi~~land ~ Illinoie
~ (Cily) (State)
$~6~ 905 3ycamore
and i resided at _ . However 1 have changed my domic~le
` (Street and Number)
to and am and havc been a bona fide ~eside~t of the State of Florida since • 15th day of
Jwqe 68 2205 South 26th Street
, 19 , and I reside at
(Street and Number)
FORT MERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual lega) residence and domicile in the State of Horida.
(Insert here any pe~tinent facts, such as sale of property or business, or relinquishment of employment
at forme~ domicile, removal of family to new domicile, purchase of home, etc:)
Son enterin; Junior Oolle~e
FILEO ANO RECORDED ~
ST. LUCIE COUhTY. FLA.
~~E.~.693`~'~.~~~~
'68 AU ~ PM 3 : 17
=:acc?? ~ aT~~s '
CLERK CIRCUIT COURT
;
; ~
i
!
iI
! ;
~ ~
~
r{{{
r i
I RJRTHER CERTIFY that 1 will oomply with all other requirsments of a lepal resident of thi: State.
1 FURTHER CERTIFY that I have no intention to ~eturn to my former domicule, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
„
? I ' i.
(Name) QheTleB N. Baum
~ ~ ~ ~ ~ '
~ ~
i
(/~dfetS~ '
Sworn b~nd subsuibed before me this 6th day of Au~Llet , 19 68
.
,,a.~~....... s
- ~~~r~~ ` Notary Public ~
~ :
_ - ;
gy 0.C. My Commis~ion ~xpins =
~
_
, .t • - - -
a. t~i:.~o.wldi,~, d~lic.f..nr fi~ ,~ili~ as~k cMaiN c.w+, .~i~d~pifo.l. ,~IM Tas A.......a =
rt S.~ i~~~ ~ ~
tla. ts-A
~.-t.;.~ r...o..t_. . _ ._~..~.~,r,:,_ - -