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Declaratio~ ot Domicile a~d Citizenship 1"743?2~3
TO THE STATE ANO COUNTY TAX ASSESSOR,
Si. IUCIE COUNTY, FlORIOA:
This is my declaration of Oomicile and Citizenship in the State of Flo~ida th~t 1 am filin~ this day in aoo~rdanoe and
in cor~formity with Chapter 222, Section 222.17, Florida Statutes.
Chicago I llinois
1 was formerly a legsl resident of
(C;ty) (State)
and 1 ~esided at _ 4801 W. Ainslie ~~Ve my domk3le
(St~eet and Numbe~)
to and am and have been a bona fide resident of the State of Florida sinae February day of
68 158 Soneto Court, port St. Lucie _
19 , and I reside at
(Straet and Number)
FORT NERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residenoe and domicile in the Staro of Horida. '
(Insert here any pcrtinent facts, such as ssle of property or business, or relinquishment of employment
st former domicile, removal of family to new domicile, purchase of home, etc.)
homestead purposes
FILED ANO RECORDEQ'
. ST. LUCIE COUNTY. F`l.q. -
RECORD VERIFIEp
1'74328
'69 JAN 30 pN ~Z ; y
ROGEF?~F'OITRAS
' . CLERK CIRCUIT COURT~
I
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1 RlRTHER ~HtTIFY that I will aomply with all other requirements of a le~al resident of thia State.
I fURTHER CERTIFY that I have no intention to retum to my former domi~ile, and 1 intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. _
(Name) rich SChmitz '
~ _ - (Address)
i: _ .
: , • .
8nworh }u arx#~xtbscribed before me this 30 day of January , 19 69 .
• _ _ . .
~ft
•-k0~ ~ITRAS
q~RIC CIRCUIT COURT Notary Pubtic
By D.C. My Gommission expires
Ro b~ ~x~cuhd in duplicM~ and oriain~l Nl~d whh Cl~eic Cira~if Cou~, aed dupliuN whh Tax Aa~s~or.)
„ ~ooK ~.75 ~;E 1628
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