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Declaratio~ ot Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR. 214424
51. LUCIE COUNTY, FlORIOA:
This is my declaration of Domitile and Citizenship in the State of Florida that I am filing this day in accordance and
in confo~mity with Chapter 22?, Section 22?.17, Florida Statutes.
I was formerly a legal ~es~dent of W~lmington, _Del.
~Ciry) ~ _ - - ~tate)
and I resided at _ 2208 ROb1ri R08d _ _ , Flowever 1 have changed my domiCile
(Street and Number)
AL1gLi8t 1 _ da of
to and am and have been a bona fide ~esident of the State of Florida since - Y
?1 St. Lucie middle School
19__ . and I reside at - - -
_ _ _ - and Numberl
800 ao. 13th Stf~~
Ft. rierce, Fla.
FORT PIERCE, SAINT LUCIE COUNTY, FLORIOA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(tnsert here any pertinent facts, such as sale of property or business, or relinquishment of employment
at former aomiciie, removai of famiiy to new domiciie, purchasa ~f hame, ~t~.)
Kevin Schwartz
~[o ~ro a~Ec
~~t io~~' ~
~uRK cu~cu~ cann h~
RlQDAD YEa~ffEO
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~ 21442
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I FURTHER CERTIFY that 1_wil) comply witfi all other requirements of a leya) resident of this State.
1r.o~-~r":~~-_ .
f FURTHER CERTIFY that 1 have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
(Name) SChw8rt2
L- ~LJh~~Vr e,
~
(Address)
Sw~m ~ artid suburibed before me this ~ day of ~~1~$t , 19~_.
~~ll~fqi~i?s ~ -
. C~ ii~j~~OURT Notary Public
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8y - y D.C. My Commission expires
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jTi7M.qrtM~d ie dupliuta •11d OII~IMI RI~ WINI CIl1'k CIKY~f COY~'1, and dupliut~ witb Tax Asa~swr.)
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