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Declaratson ot Domiclle and Citis!?: ~h1p
TO THE STATE AND COUNTY TAX ASSESSOR.
Sl. lUC1E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizcnship in the State of Flo~ida that 1 am filing this day in accordance and
in conformiy with Chapter 222, Section 222.17, Florida Statutes.
Lexin gton Park Maryland
1 was formerly a lega! resident of -
(Cify) (State)
and I resided at __-_~2__W Rene~ll However 1 havechanged my domiti~e ~
(Street and Number) ~
to and am and have been a bona fide resident of the State of Florida since ____.I-La.ljl_- -.~~3~ day of j
t and 1 reside at Route 2 box 3615 Lakewood par~ ~
9- .
(Street and Number)
PORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile i~ the State of Horida. ~
~
(Insert here any peninent fads, such~as sale of property or business, or relinquishment of employment ~
at former domicile, removal of family to ~ew domicile, purchase of home, etc.)
Eatablishing Do~icile ~
i
~
,
,
~ FILEO AND RECORDED
ST. ~UCIE COUNTY. FLA.
R~:COR~ VERIFI~D
1631`72
.
~ '68 JAN 2 AN 10 . S 9 ~
.9' ~
.:e:~~r ~•o~TR~S
CLERK CIRCUIT COURT
1 FURTHER CERTIFY that 1 will comply with ail other requirements of a(egal resident of this State. ;
~
~
,
I FURTHER CERTIFY that I have no intention to return to my former domiG~e, and I intend to remain in FORT _
PIERCE, SAI(,~j;1.41CIE COUNTY, FLORIUA, permanently.
~ •.~'•`1•/,•''~:: ? , ~
_ . ~ , ~ _ ~ - ` (Name)
_ ~t ' - " ~ - - ' Leroy C. Schwier
_ V'~: - ' - ~r~~
(Address)
.
(/n ~ Et?`,G`,,`~~~ -
Swom ^fo~d wbxribed before me this day of , 19 -
ROGER PORRAS
CIRCUIT COURT Notary Public ~
i^~~~ct-e.,6...c.e !O o~e~!
l~LL -
gy D.C. My Commis wn exp~ es
(To b~ ~x~aN~d in dvplicat~ snd ori~ieal ~il~d whb Cl~rk Ci K Cour~, and duplicah with Tax Ass~o?.)
~
; 6~;~169 P, ~2589 ~
' No. 13 , ~ _ - - -