HomeMy WebLinkAbout0726 _
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Declarat3on r~t nc~micil~ a~nd ~iti~enship _4 ~Y ~ ~ri
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, ~LORIDA:
Tt~is is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in a~cordance and
in conformity with Chapter 222, Section 222.17, Florid-a Statutes.
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Milwauk~ee 4Yisconsin ~
I was formerly a legal resident of _
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(City) (State) ,
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and ! resided at 2729 S 102nd Street _ Npwe~e~ I have changed my domitile
(Street and Number)
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to and am and have been a bona fide resident of the State of Florida since Y ~
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_ January ~q__6S and I reside ar ______270b S lbth Street ~
(Street and Number; j
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FORT PIERCE, SAIPIT LUCIE COUNTY, FLORILIA , ~
and this statement is to be taken as my declaration of citizenship, actual legal resiaence and dor~r~ieiie i~ itiz Sfaie ~f ~l~~ ~~a.
(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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~stablishin~ r~s idence '~6 JnIJ ~ 3 {
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~ ~i. LUCIE COU~:iY. ~
_ FLORIDA ~
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; I FURTHER CERTIFY that I will comF~y with all other requirements of a legal resident of ihis State. ~
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I FURTHER CERTlFY that I have no intention to return to my former domi~ile, and I intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
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(Name)
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~ - . , y - Hea1y, Mark
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.a `r t %~r ` ~ (Address)
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~~~.j~'"-.~;~- 13 JanuarY 19 66 ~
Swom'.to~ and subscribed before me this day of - , '
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ROGER POITRAS
CLERK CIRC T COURT Notary Public ~
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gy D.C. My Commission expires
(To be executed in duplieate and original filed with Glerk Circuit Court, and dupliute with Tax Atsessor.)
BOOK136 ~z~