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ii~ TiiE STATE ~N~ CCGU~lT1' TAX ASSE~C~:,
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Sl. LUCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Ciiizenship in the State of Florida that I am fifing this day in accordance and
in c.onformity with Chapter 222, Section 222.17, Florida Statutes.
Lamha~ in
I was formerlv a leoal resident of prince George COUIIty Md.
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(City) (State)
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5307 85th Av_e_~_____ . However I have changed my domi~ile
and I resided at _ - - _ - -
(Street and Number) '
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16 t h____ da of ~
to and am and have been a bona fide resident of the State of Ftorida since _ y
~ecember ~o b5 ~ r~s~~P a, Rt 2 Box 5397 Lakewoad Park
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(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, FL~RIDA
and this staternent is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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Establishing residence . ~
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RE~pR~ OOK r
FII.ED~AN~ QL~-
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f 6 PM 1; 57 1
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_ C~-ERK x
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= .f'~,;,~~;~~; ~i~FU~~Fl~R,CER'iIFY that I will comply with all other requirements of a legal resident of this State. ~
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1 FURTHER CERTIFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT ~
~ PIERCE, SAINT LUGE COUNTY, FLORIDA, permanently. ~
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: - (Name) ~
~ - " Duane Arthur Bittner
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- (Address)
! ' ~~..$worn ta ~and subscribed before me this bth day of _ Januar~ ~ ~q 66 _
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ROGER POlTRAS '
i RK CIRCUIT CO T Notary Public
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, g~ ~''G' D.C. My Commission expires
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(To be executed in dupiicate and original filed with Clerk Ci~cuit Court, and dupliute with Tax Asseswr.) ~
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