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Declaration ot Dorricife and Citi~enship
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TO THE STATE AND COUNTY TAX ASSESSOR, .
Sl. WCIE COUNTY, FIORIDA: `
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This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in acoo~danoe and
in oonformity with Chapter 222, Section 222.17, Florida Statutes. -
Milwaukee Wisconsin
I was formerly a legal resident of
(CiN) (Staro)
and I resided at _ 3634 So. 24th St Iett , Hcwever I have changed my domicile ~
(St~eet and Numbe~) _ ;
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to and am and have been a bona fide resident of the State of Flo~ida si~ce Aug. 10 day of
, 19 69, and 1 reside at li3 Yacht View Lane ~
(SNeet and Number)
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my detlarotion of citizenship, actual legal residenoe and domicile in the State of Horida. ~
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at forme~ domicile,~ removal of family to new domicile, pu~chase of home, etc.)
Filing ho~estead exemption
FII.E~ AND RE~~~~
~~T. LI;C{E COUrl ~ FLA. ~
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~~_~Zs-; .r,:;~~UtT COURT
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I FURTHER CERTIFY that I will oomply with all other requirements of a leyal ~esident of this State.
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~ I FURTHER CERTIFY that I have no intention to retum to my former domi~ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIUA, permanently.
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~ (Name) hn Buczwinsri
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; (Address)
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~ Sworn to and subscribed before me this 9th day of J~Vary ~ 19 70.
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~z , . ~ , ROG~ <POlYRAS
~ CLERK GRt~IT COURT Notary Public '
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~ By r' D.C. My Gommission expires '
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~ (To ~x~cut~d in dupliut~ and ori~insl fil~d with Cl~rk Cirwit Court, and duplicat~ with Tax A~ssor.)
~ aooK 1~~ ~~E 45
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~ No. 13
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