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oeciaratio~ ot Domicile and Citize~shlp 2 0 7 2 3 3 ;
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TO THE STATE AND COUNTY tAX ASSESSOR,
i
Sl. IUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in ecto~dance and
~n conformity with Chapter 222, Section 222.17, Florida Statutes. _
1 was formerly a legal resident of ~LC.~ _~d~~______ _ 1__~~ O
(CitN3 (State)
and 1 resided at ~~~~~T _ _ . However I have chan m domi 'le
~d y G
(Street and Number)
~o and am and have been a bona fide resident of the State of Florida since ~I~~~ day of
_
, 19~Q-, and I reside at~.,Za8__WESTNlc~e~«D ~c~!A__ .
c (Sy eet and Nu ~C ~C~
FORT PIERCE, SAINT LUCIE COUNTY, RORIDA ?°~T L~U C/~
~o~~~d
and this statement is to be taken as my declaration of citizenship, actual legal residente and domicile in the State of Florida.
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.) E
~'ST~t~G~S~ ~~SJj1t~,~C~
207233
_ s~~iuciE cou~Y ~i~i.
~aceR PoitR~s ~
CLERR CIRCUIT COUAt
RECORD YEtlIt1E0
~ttt ~ Z 9 26 ~M'1 ~
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~ I FURTHER CERTIFY that 1 will oomply with al) other requirements of a legal resident of this State.
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~ I FURTHER CERTIFY that I have no intention to return to my former domi~ile, and 1 intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~Si ~E G ~ a/ . .h/dC F
~ (Name) Russell J. Wolf
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5
(Add~ess)
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~ Swom to and subscribed before me this ~ day of - , 19..~.
- ^ .o . Jt~ .f/.,^/ -
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`v" ~ Notary Public
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~y - ~ D.C. My Commission expires
:`t~ :
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y •~erl~d ~p1"d~plluh and oripinal ~il~d with Ci~rk Grcuit Court, a~d duplicsts with Tax Ass~ssor.)
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~ s ` ~ 191 1~28
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~ No. t3
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