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De~f~ra~tlon t~~ Dot~l~ctle ~~d ~ltlzenship ~
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TO THE STATE AND COUNTY TAX A~.SESSOR, •
ST, lUC1E COUNTY, FIQRiDA: ~ ~
~ Thii i: my declaration of Domicile and~Cltizenship in tha State af ~lorida tha4 I am filing this day tn ~ccordenco and
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(n oonformtty wlth Chapter 222, Section 222,17, Flortda Statutaa. ~
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~ New York
1 wa: forme~ly n lega! resider~! of - 1~dp a~ g~ hC1.14Qt3 ~,9 I,.
. (Ci4y) (State)
and 1 resided et 301 Berg~n Ave. . Hewsver I have ctianged m~ domlc.ile
(Street and Numbe~) . ~
b and am and h~ve been a bona fide resident of the State af Florlda since . 4 tb day of
~04 B1 S3d
~y November , j9~4 and I re~ide er o Court Por.t St. Lu~ie .
~ . (Straet and Number)
" !'4RT MERCE, SAtNT tUCfE COUNTY. RORIDA •
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~ and thi: atatement is to ~be taken bs my daclarotion of citizenship, actual leg~l ~esidence and domiNle in the State of Norida. '
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(Inse~t here any pertine~t facts, such as sale of property or business, or reltnqui:hment of employment
at former domicila, removal of family ta new domicile, purch~sa of home, etc,)
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Bstablishing xesidcac'
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- Wii~ appiy fot homeste~d after the f~rst ~of the year
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FI - f~D RECQRDED , ~
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, ~ Ih. ~ e~.___....~rd~~OK ~ ~ r ~
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. 1964 NO ~ I 8 a~t 1 I : 04 ° • . ~ , ~ ~ i
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~ RQGCR POiTRA5 CLCRK . - ~ ~
~ QT j (f r /f~Jy . .;i;i,~ :
t . . . . ~ . _ . ~ VI• L~I/~L lIO~17~{, FlORIOA ~ ~ . ~ ct~t~r .
- . . . . _ - 1 . . ' ~ ~ ' `'~~~11/111\~~~, .
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{ FURTHER CERTIFY that 1 will a~mply with all ather requiromenh af a le~) rasident of this St+~fs.
_ 1 FURTHER G~RTfFY that I have no intentton to retum to my former domic,ils, an~d 1 intend to remaln in FORT
:;s . PIERCE. SA~jy~,T~1,~CIE COUNTY, FIORIDA, permanentiy. . .
n ~~'1S : ~t! -
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, ' ~ ~ ~ ~ ;fy • ~,/~0 _
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r~: f . , . ~ ;i CA ;
; , ~ r,, _ . ~ (Nartte)
~ Jos ph Harsche
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• _ (Addnss) -
~ + ~ - 18th November ~ - --~4 : .
, • ta-and subscribed bsfore me t'~1s day of i9
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. _ ; RA~ ~OITR/~,f~ ' . . .
ClRCUIT AURT IVotary Pubik +
.?.~..G~.,~i ' . . ~ : . ~
- - dY D.C. My Commiuion ~xpt~~
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_ tTo b~ pcsar~d la d~p~ aNd ari~~l NMd wNl~ C~c ~ksMi1 Co~r1, a~i Tax a
~ _ 60014 ~ fACfA~~
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