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Declaratio~ ot Domicile and Citizenship 1'791.85
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. IUCIE COUNTY, FIORiDA:
This is my declarotion of Domicile and Citizenship in the State of Florida thst I am filing this dsy in aaoordante and
in oo~formity with Chapter 222, Section 222.17, Florida Statutes. ~
I was fwmerly a legal resident of Seldea Long Ialaad~ N•Y~
(Ciy) (State)
and 1 resided at 11 ~~a A~!• . However 1 have d?snged my domic,~le ~
(Street and Numbe~)
to and am and have been a bona fide ~eside~t of the State of Florida since 18d day of
_ ~;aie , 19 69, and i ~es~de a~ ~SOS Hexport Dri~e ~
~ (Street and Number)
FOR? MERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is so be taken as my detlaration of citizenship, actual legal residence and domicile in the State of Horida.
(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.)
BnterinQ Joha in 2nd grade
~
Yeith in tindegarten
FILEO AND~ RECORDED~! :
ST. WCIE COUNTY. FL.A. ` j
RECORD YERIFl~p ~
. 1'~'9185 ~
'69 JUN S PM 2: S 7 ;
G~'
~i ROGER ~OITRAS
~ CLERK CtRCUIT COURT.' ~
~
I
i
~ 1 RJRTNER CERiIFY that I will oomply with all other raguirements of a(eyal resident of this State.
I FURTHER CERTIFY that I have no intention to retum my rmer do ic.ile, 1 i to remain in FORT
PIERCE, SAINT LUCIE_ COUNTY, FLORIDA, permanently.
; t~~e ~ t ~ ~„r,~ f.,;.
t , t
~ • y ''ir\ -
~ ~ 1'` • ' G~ ~ ~ (Name)
~ ~ ~ f
- ~ `~j'; Jobn w. Schneider Jr.
~ . ~ - `
~ • '
• ;
i' ; (Address)
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~ E~•` ~ yr~ June 1969 d
~
~ ~~~'Swet'ri to and subscribed before me this Sth day of , 19 •
~
~
~ RO~iER POITRAS
~ CIitCUR OURT Notary Public
~ ~~j~~ i
By ~n%~`~""'~ D.C. My Commiuion expires ~
,
:
~ Rs b~ ~x~arf~d i~ duplicab and ori~inal Rl~d wilb CM~k Cirwif Court, and dupiicaN wi~h Tax As~or.)
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