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Declaration ,.~~-1?~~~~V.erl ?nd Citizenship
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TO THE STATE AND COUNTY TAX ASSESSOR,
St. Lucie
COUNTY, FLORIDA:
rhis is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance.
and in conformity with Chapler 222. Section 222.17, Florida Statutes.
I was formerly a legal resident of
Chicago
(City)
Illinois
(S",.)
and I resided at
2224 ~est Oakdale
(S'r..' end N"",ber)
However, I have changed my domicile
to and am and have been a bona fide resident of the State of Florida since
7th
day of
Au:ust
. 19
, and I reside at
1103 Sunrise Blvd.
(S'rH' and Number)
Fort Pierce
(City)
and this statement is to be taken as my dedaration of citizenship. actual legal residence and domicile in the State
of Florida.
St. Lucie
County. Florida.
(I....., her. any perti....., fKh. .uch .1 .... of property or buli...... or ralinquw.m.n, of employ......, a' former domicile.
remov.1 of family '0 new domicl", purche.. of honw. .tc.)
Entering in public school:
Michael Louis Lefkovitz
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I FURTHER CERTIFY that I will register at my locel addr..- when the registration books reopen, and comply with
all other ~equirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in. --
Fort Pierce
(CItyl
St. Lucie
County, Florida,
perma,~ly:; "....
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~ester~~ .
10) Sunrise, Fort Pierce,Fla.
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Sworn t6:.uiJ~obKribed before me this
(Addr...)
2ls.t -
day of _-AuguS.t
.,19 61
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ROGER POITRAS. aERI~.?RCUIT COURT
By ----m~ _E._J_~ --- - - - - D.C. My Comm;".... exp;,.. .. - -- n --
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Notary Public
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