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Declaratio,n ot Dorr~icile and Citizenship
TO THE STATE AND COUNTY TAX ASSESSOR, ~
Sl. lUC1E COUNTY, FLORIDA:
This is my declarotion of Domicile and Citizenship in the State of Florida that I am filing this day in accordance and
in co~formity with Chapter 222, Section 222.17, Florida Statutes.
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1 was formerly a legal ~es~de~r of _ Philadelphia Penn
(C~ty) (State)
and I resided at _ 4316_E. Stiles StY'@@t However 1 havechanged mydomiCi~e .
(Street and Number) '
29th ~
to and am and have been a bona fide resident of the State of Florida since day of 1
September , 19
64, and I reside at 1601 JusIIita Ave
(Street and Number) _
FORT PIERCE, SAINT WCIE COUNTY, FLORIDA
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and this stateme~t is to be taken as my declaration of citizenship, adual legal residence and domicile in the State of Horida.
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(Insert here any pertinent facts, such as sale of property or busineu, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
Establishing residence and applying for homestead
FILED AND RECORDED' I
ST, I.UCIE COUNTY. FLA:
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.ig ~ ~~~u
~ '~0 JaN 6 AM IQ : OS
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t:~ :0';~R:.S
CLERK C=?~CUIT COURT
I FURTHER CERTIFY that I will comply with all other requirements of a lega) resident of this State. ~
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I FURTHER CERTIFY that I have no intention to return to my former domitile, and 1 intend to remain in FORT ~
PIERCE, SAINT LUCIE COUNN, FLORIDA, permanently. ~
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. . n ~'2 ! o ~
. ` - = r; (Name)
, - ; ;'~.~"j Charles Golob
s
, _ 1
' ~ _ _ (Address)
,
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~ . ' 6th Januarv , t9~S2.
;$woih'fa and subscribed before me this day of
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~ ROGER POITRAS -
~ K CIRCUIT COURT Notary Public
By ~~~G D.C. My Commission expires
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(To b~ ~xecuted in duplicate sed ori~inal filed with Cl~rk Grcuit Court, snd duplicsM with Tax Ass~or.)
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~ BooK 1~2 P~~E 214
~ No. 13 _
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" _~_v. _ . . .