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5 flU? ~ - LEONARD
Declaration \jf L~.b~l~ fbhd Citizenship
Je STEIN
'fO THE ~'TATE AND COUNtrY' TAX ASSF~~R.
ST. LUCTE COUNTY. FLORIDA:
This ia my declaration of Domicile and Citi.zenahip in the State of Florida that I am filing thi3 day in
accordance, and in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a lepl reaid~nt oL_____m. f~hicago-...----.-.-- _____________._.___nmn___.' _;tJ-:~J-~gJ-~---.------.----.---
(Citf) ~ 0) (State)
and I resided aLUnlmo\ffl LlClS.t___)..i.y~_9..__~_h_~r.e.JO ye?-_r~/trowever. I have changed my domicile
(Street aDd Number)
to and am and have beer. a bona fide resident of the State of Florida ~ince .._H .5.th. ._.n n _n..___n. day of
_ n .____m___p.~_~_~!~!?_~!'.________._____._m' 1~-.--, and I reside a t),._Q.5mQ~'~~~_~~__h9_<?_~.r_~.J.P_~;:_~_? ~-...-.-!-.~-<?~.~---.
(Street and Num~r)
... f.9rt .J'J.~_~~_~mn..___n__________n__.____._n____'f _~_~..~_._.~~ C i.~.__ ___n~__.__..___._n_. __no. ___._____ -.'_ _CoWtty. Florida.
(City )
, and this statement is to be taken as my deelan>tion of citizenship. actual legal residence and domicile in
the State of Florida. -
(Insert here any pertinent facts, auch aa &Ale cf property o~ ouaineu. or rellnquiahment of employment at
former domicile. removal of famil)" to new domicile. purch..e of home. etc.) -
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I FURTHER CERTIFY that 1 will register at my local address when the registration book!! r~pen.
and comply with all other requirements of a legal resident of this State. -
I FURTBER CERTIFY that I have LO intention to return to my fom:.er domicile, and I intend to remain
::.:~~::~.-I'~-e~"~-iCitYi---- - ___mnm____m_.__/':Y-'mr.ll:"i-e~n---~ty. Florida,
4.~L --' n__.m_.__m_._m___
( ~
Leohard J. Stein
----. -.-------------------------- --- -------------- ._-------.--- ~---- -------- ".---
(Ad<lrea:: )
Sworn to and 8ub.~'h9d bdc.re mp, this ---l5.t&y of
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lc~~~~h <.'.~.:....::... ", A D 6'
_~.J,.;.l.L__._,.)....:-;--~:,..!-. .__,.. 19.___e..
~n . v..' .~. t-,_:.y', ':. . '
,/ /~~tfl!!.:ur;.~--F?':,- - .f'C'--?cbt/
---r--~~-p;r~iit-.- of' . d4& ai--~..m---m---
. .~ .~\ ,,! . ,.,. .:...' 6 '21. '63
My COmm.iasi0f.l;'~7.---:--....-~..--J.--.
.. " ..t ~.. . ""'"
(To be exfe\i~~~~tt'r.nd oricina1 ftled with elm Circuit Coun.. and duplicate with Tax Auuaor)
R.._n gDDDIY Ce.. Pla..t City, Fla. ·