HomeMy WebLinkAbout0149 . - . . . ' ~ i
Dectarat~on ~ot Domicile a~d Citizenship .16942'7
TO THE STATE AND COUNTY TAX ASSESSOR,
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Sl. LUCIE COUNN, fIORIDA: ~
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This is my declaration of Oomicile and Citizenahip in the State of Florida that 1 am filin~ this day in eoo~dano~ and
in cor~fo~mity with Chapter 222, Snction 222.17, Florida Statutes.
1 wa: formeriy a legal resident of ]~ebraeYa
(City) (Sfafe)
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and 1 resided at 4725 South 51 StTeot ~ods 6811T _ However 1 have chanqed my domitile -
(St~eet and Number)
to and am and have been a bo~a fide resident of the State of Florida since 16th day of
Y8~ - , 19 68 , and I reside at 2201 8outh 29th Street _
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA -
and thi: statement is to be taken as my declaration of citizenship, actual legal residence and domiale in the State of Horida.
(Insert here any pertinent fatts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicite, purchase of home, etc.) -
:
Sntering David 8lohard Olsen ia 2na ~8a• oY eohool.
David ie grandeon of Yre.I~oui~ B. Oleen, Jr., but makee .
hie per~anent homa with her~ aad hae lived with her einae
he wae born.
' FILED ANO RECORDED?
' ST. ~UCIE COUNTY, FLA:' "
~ • RECQRG VE. t~1~D
~ 16~19~~
~
'68 All6 8 AM 10 : y7
RQ [~R F'O~T~tiS
• CLERK CIRCUIT COURT
1 FURTHER CERTIFY thst i will aompiy with ail other requirementt of a legal'resident of this State.
~ 1 FURTHER CERTIFY that I have no intention to retum to my former domiCile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, flORi~A, pe~manently.
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(Name) Yre. Louie B. Ol sn, Jr.
(Annie)
(qddress)
: - !
~i,i~lttic;;y~~ " s ~
S ~~~~~~~bTe~d s~~i6ed,before me this 8th day of SuBuBt , 19~$. ;
. ~ ~,t ' .
. ti~' ; GUtQUQ W'~.~~'~~; f-=.
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` ~~~~lT t . • p = .
, ;CpUkf: . - . Notary Public
~ ~~-~-i~ ~ :
gy ~ ' ~.C. My Commis:ion expi~es
. i~ : . •
~,~~~h .e,s~r1~~,
.1'.
(~p
~bi,~x~wwt~d ,in ,dupliut~ aed originsl filed witl~ G~rlc Circuit Cou~t, and dupliw» with 7ax Assts:or.)
~ 0~1?3 148
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