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L?eclariatioll of Domicile and Citiz~nshi~ aoRx ~~, f"GE~U !
TO THE STATE AND COUNTY TAX ASSESSOR,
3T. LUCIE COUh`TY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I 3m firing this day in accordance
and in conformity with Chanter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident ofhioitg0 Illinoi9
[City] State
and I resided at_ ~4~ Soyth Faj.rfield However, I have changed my domicile
[Street and Number]
to and am and have been a bona tide resident of the State of Florida since _-__ 18th day of
November _ I9_62 and I reside at _ 4C?5 ~oeonut Ave,kiver Park
[Street and Number]
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA,
and this statement is to be taken as my declaration of citizenship, actual legal residence an'1 domicile ir, the 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, ete~)
Establighill~ residen0y
Purchased a home
11_~)88i
fIlEO AND RECORD~ODK
1962 DEC _~ pM I I : OS
ROG CE ~pDNRASFLORi~DA
SZ . lU -~
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply
with all other requirements of a legal resident of this State.
I FURTHEP. CERTIFY that I have no intention to return -to my former domicile, and I intend to remain in
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
x ~~~
John Schr~e~~
[Address]
S~~orn to and subscribed before me this 4th oy, ~ December _~ I~__ ~
_ --=-y- ~------
ROOI" POITRnS ~,~ .LJ~ ° .~.~~~•~~" • ------ -- - -- - -
CLF.RI: CIR~i:IT CO~~RT :;`: ~' Notary Public
~l, ~ GOO{-s~C_I~GG~ - D.C: v ; ~ ~~ ~f~' Comrglssion a spires-.--
- v~~-sue. ~~ "` --
~ L `'_~~;
[To be executed to duplicate attd original filed n•ith blQtft Cirou2t~Court, and duplicate with Tax Assessor]
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