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D laratio~ ot Domicile and Citizenship "169~819 `
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TO THE STATE AND COUNTY TAX ASSESSOR. . ~
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Si. LUCIE COUNTY, FIORIDA: -
This is my declaration of Domicile and Cltizenship in the State of Florida that 1 am fili~q this day in aooordano~ and
in oonformity with Chapter 222. Settion Z22.17. Flarida Statutes. ~
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8uclid Ohio
1 was fotmerly a ley~l tesident of +
(City) - (Stst~)
and 1 resided at 130 Bast 191st St re~t my ~m~1e ~
` . (St~eet and Number)
to a~al am and have been a bona fide ~esident of the State of Fiorida since June d,y of
_ ; 19~, and 1 reside at 169 Vindale Avenue
(Stroet and Numb~r)
PORT PIERCE, SAINT LUCtE COUNTY, FLORIDA
and this stetement is to be taken as my declaration of citizenship, actual legal ~esidenoe and domidle in the State of Flaida.
pnsert here any pertinent facts, wch a: sale of propery or business, or relinquishme~t of emplaymsnt .
at former domicils, renwva) of family to new domidle, purchase of home, etc.)
: Bntering children in school - Michael & Lisa ralumbo
~ILEO AND RECORQED ~
ST. LUCIE~ COUNTY. FI.A.;
RE~91~Q~(~F~~IED
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'68 Al+r 2 2 A~I I I: 3 I
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~ER i'OITR~S
~ . CLERiC CIRCUIT CO RT
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, 1 FURTHER CERTIFY tfiat I will aomply witfi all other roquirements of a lepal'~esident of this State.
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1 FURTHER CERTIFY that I have no intentron to retum to my former domivle, and I intend to remsin in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently. n
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(Name) ~o AnD Paluvbo
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V " , i ~ . (/4dd~ess)
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A~~.~- . ` Augu s t 6 8 ~
S~wc~to ~nd wbs~tibed befor~ me this 22Ad ~y ~ 19 . ~
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ROGER rO1TRAS ~
CLERK CiRCUiT Notary Publk
8y O.C. My Canmis~ion ~xpins
(i. b~ ~.a ia drpik.l..na .ei~iw.~ R{.a ,wid~ u«k ckaM c.w~, .wa ~plia~. wi1~ Tax A.......a
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