HomeMy WebLinkAbout2604 Oeclaration ot Domicile and Citizanship
TO THE STATE AND COUNTY TAX ASSESSOR.
51. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Gitize~ship in the State of Florida that i am filing this day in aooordanoe and
in o~nformity with Chapter 222, Section ~22.17, Florida Statutes.
1 was formerly a legal ~esident of t"iadison Wisconsin 53711
(City) (State)
and I resided at ~ 4209 Waban Hill . However 1 have chsnged my domk3le
(Stroet and Number)
to and am and have been a bona fide resident of the State of Florida since the first _ day of
Lot 12, Block 1422, Port St. Lucie Development
January ~ 19 69 , and I reside at ~~neral Bevelopment Corp) Ft Pierce, Florida
(Street and Number)
fORT PIHtCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, ach?al lega) residence and domiale in the Stab of florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at fo~mer domicile, removal of family to new domicile, purchase of home, etc.)
Place of Birth: Madison, Wisconsin. Date Last resided in Wisconsin: Apr 56.
Occupation: Serviceman (Master Sergeant, US Army) Station: USASATC&S, Ft Devens, Mass
Service number: RA 16 528 394, Social Security number: 391 30 0993.
Upon retirea?ent from active cailitary service, I intend to reside in Fort Pierce, Florida.
I further certify that all taxes that I am required to pay to the State of Wisconsin
have been paid in full through December 31, 1968. I further certify that I own no
FIl~O AND RECORDED ;
other property other than in the state of Florida- ST, IUCIE COUNTY. FLA. ~
' ~'r_~C)F2;'t VER{~'EG i
I 1-
~'"712~ i
~ '69 APR 18 AM {0:4~ / >
~ Q,~?
:O::L:k i !7R%+
CLERK ~1RCUIT C4URT
I FURTHER CERTIFY that I will comply with all other requiremenn of a le~al resident of this State.
I FURTHER CERTIFY that 1 have no intention to return to my former domitile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. - -
DdAVID LY ~ `
(Name)
_ . . _ ;
. ~ r Hqs, USASATCb~S
~ _ ~ Fort Devens, Massachusetts
; ~
- ~ ~ :.s~;;' (Address)
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Sworn to a~d subscribed befpi4~me this "~T~-.:
, day of , . 19 69
. , _ .
: . . - ~ ~ l
` ~ ' ~ • Public -
CLERK CIRCroU~COURT , "T ICNAEL J. ~
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3. ~ , . ~ . _;;~~~~`Y- CP?, MI
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. , : USASA?CiS
~ Fort De~rsas, Masuchus~tts 01433
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