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Declaratio~ ot Don~icile and Citizenship ~ b 7 S 0
TO THE STATE AND COUNTY TAX ASSESSOR,
Si IUCIE COUNTY, FIORIDA.
Th~s u my deNaraT~on of ~om~ule and Cit~zensh~p ~n the Sta~e of Flonda that I am fil~ng this day ~n accordsnce and
:n confofmity w~th Cha~ter 222, Section 222 17, Florida Statutes
! was formeriy a legal resident of S@8tiQ_ _ _ _~SSY1IY.~LOII _
(Ciry) (State)
~nd 1 resided at 4?00 Is? an3 Crest R`a
_ _ _ _ _ _ _ _ However i have changed my domiti~e
(Street and Number)
to and am and hav~ beer, a bona fide resident of the State of Fiorida s~nce 25~ day of
1iaz~Ch ~q_71 . and I reside at _._3301 A. Indian River Drive
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(Street and Numberl
FORT PIERCE, SAINT LUCIE COUNTY, FLORiDA
and this starement ~s to be taken as my deciarat~on of ~~tizenship, adunl legal residence and damicile ~n the State of Florida.
tlnsert here a~y pert~nent facts, such as saie of property or business, or relinquishment of employment ~
at former do~icile, removal of family to new domicile, purchase of home, etc.) }
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(School Children)
l~arv - lOth Grade
l~argaret - 9th Gr~de
~i~~~~ - Bt~ Grade 2 p~ 7 6 0
l~arie - 6th Grade
ltatthews - 5tn Grade f«EO ~?Me ~ECQ~t~E~ ~
sT. ~uc+~ ~ou~Tr u?. '
QOCf F~I?~S
CLEIIR C~M.:IIIT COURT
RECORO rER+FiEO
` M~ Z9 II oe ~M'T I
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~ I FURTHER C~itTIFY that I will comply with a!I other requirements of a feyal resident of this State.
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y ! FURTHER CERTIFY that I have no intention to return to my 4ormer ciomicale, and I intend to remain in FORT
: ~I~RCf, SAWT LUCIE COUNTY, FLORIDA, permanentfy.
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f ~ ~ George . Schiltz
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; Sw~rn ~o and s~bscr~bed before me this _--2 t~ dey of 1~8TCII ~q_71 ~
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ROGf~ POHRAi . _ • ;
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~ Notary Public
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' 6y ~ _ _ D.C My Commission expires _ _ _
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, tTo b~ ~~11 i~ ~fiie~t and oripin~l fibd wi1i~ C{~k GrcuN Couri, and dupliut~ wiM~ Tax AsMS~w.)
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