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Declaratlon ot Domicil• and Citizenship -~5937'2 ~
TO THE STATE AN~ COUNTY TAX ASSESSOR,
51. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filiny this day in aooordenos and
in conformEy with Chapter 222, Section 222.17, Florida Statutes.
BRESZEWOOD PA.
I was formerly a legal resident of
~Cify~ (Steis) 1
ar~d I resided at ~l~ However I have thanged my domi~ile '
(Street and Number)
~ da of
to and am and hsve been a bona fide resident of the State of Flo~ida since Y
Luguet , ~q 6? , and I reside at 2 Box ?5-3
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, RORIDA ,
and this statement is to be taken as my daclaration of citizenship, actual legal residence and domicile in the State of Floria~.
(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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Filing for hamestead purposes _ ~
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FIlEO ANO RECOROED !
57. LU~~ ~
ERIF EOLA~ ~593'72
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CLERK C
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I FURTHER C'HtTIFY that I will oomply with all other requirementt of a leyal resident of this Stste.
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I FURTHER CERTIFY that I have no intention to retum to my former domiGle, and I intend to remain in FORT ;
i
PIERCE, SAINT Lt1CIE COUNTY, FLORIDA, permanently. #
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' s: ~r".c~: (Name)
.,r~ ' ~ ' ~ • J. RobertRolm
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: ~ _ ~1 s»' . = 231`d August 6?
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Syvei~q'~.tp `~an~~siibsuibed before me this day of •
.
• _ . - • .
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~ . QaE~ ,
' CIRCU OURT Notary Public
g ` ~.C. My Gommiuion expires
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(To b~ ~x~cvl~d in duplicafa and ori~inal fi{~d wifh Cl~elc Circuh Courf, and duplicah with Tax Atws~or.)
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