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Declaration ot Domicile and Citlsenship
TO THE STATE AND COUNTY TAX ASSESSOR, 143~~~~ j
Sl. LUCIE COUNTY, FLORIDA:
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T~is is my declaration of l~omicile and Citizenship in the State of Florida that 1 am filing this day in accordanca and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
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Clevelan~ Ohio ~
I was formerly a legal ~esident of . _ - i
~C;ty~ (State) i
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33~n ~ 93rd StiEet . However 1 have chsn ed m domic,ile ~
and 1 resided at - - - - 9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since ___3 _ day of
actober 65 416 N 6th Street
19____, and 1 reside at
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(I~sert here any pertinent facts, such as sale of propery or business, or relinquishme~t of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FI~ q E~ ROED
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Bstablishing residence F~=~~~VCD gOOK
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'ss MAR I 8 AM I I: 2q
14365,~y
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v:~~,,X ROGER PO:TRAS. C~E •
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_ Q. ST. LUC1E COUNTY
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: SJ v • r•~ ~ FLORID •
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I FURTHER CERTIFY that I wil) comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiqile, and I intend to remain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently_
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' `S~ (Name)
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4'-~ Steve Hrubey
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~ ' ~~~C~~•'`~''~• i8 March $6
Sworqtll~:~~~subscribed before me this day of . 1 •
ROGER POlTRAS
CLERK CIR IT COURT Notary Public
gy D.C. My Commission expires
(To b~ ~xscuted in dupliute and originsl fiisd with Clerk Grcuit Couirt, and duplic~M with Tax Ass~stor.)
BooK 140 55i
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