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Declaration ~ of Domicile and Citizenship
TO THF STATE ANU COUNTY TAX ASSESSOR,
~T~_!~~C.t COUNTY, F~oRina: 252461
This is my declaratian of Domicile and Citizenship in the State of Florida that 1 am filing this day in 3
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accordance, and in conformity with Section 2''2.17, Florida Statutes. ~
l was formerly a legal resident of ShF.ronville Ohio ~ and I -
(c~~r) ~sa~o~
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rrsided at ~orne]1 Road However, 1 have changed my domicile to s
(Slrrrt and Numbrr)
and am and have b~en a bona fide resident of the State of Florida since __26.tY~~ day of ~
will
h~h-- 19_?1___, and 1/residc at _
L_ot Rols.~. and 2 Block 2~~_
(Strcet and Numtxr)
_Port St._Lucie St. Lucie County, Florida,
lc~~r)
and this statement is to bc taken as my declaration of citizenship, actual legal residence and domicile in the State
of ~Ftorida.
•(Inseri here any pettinent facts, such u sale of propcrty w business, or relinquishment of employment at former
domicile, removal of family to new domicile, purchase of home, etc.)
a. I left the state of Ohi.o on 12 Octaber 1'954 to enter the ATavy and
have not returned to that st~te for ar;y reeson other than brief x~eriods of
~:ii.li.tary ~eave. '
b. The proper~rdescribed above in Port St. Lucie was purchcsed by r.?e on
25 N':sch 1971 for the e~ress puroose ~nd in~t,ent of residi.ng perc~enantly in Florida
upon r~y retirerient ior tY:e U.S. hT~_vy in afea years.
c. I am a registered voter of St. Lucie County, Florida.
f1iEe ak: ~~.:O~oED
ST.IU~;~ C~UH'iY FLA.
RO~i F = ."s '°•AS ~
ClE~R (J :Y~J~I CGURT
4F!`oSC ~
Ars i9 10 ss AN'73
- 252461
1 FURTHER CERT[FY that I will register at my Iocal address when the registration books reopen, and ;
comply with all other requirements of a(egat resident of this State. '
' 1 FURTHER CERTIFY thai I have no intention to rcturn to my former domicile, and 1 intend to remain in '
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Port St. i,ucie ~,u~i~- County,
Florida, permanently. t~"y ~
` ~~~'M ~
~ ~ obert L. Si7RFACE
- - (lsame
• Co~-~ander, U.S . :iavy
(q~dreu ~
Quar`„ers 5, U.S. •.ava~1 Acade~~y
Swom to and subscribed before me this ~tr day of ~$?olis, I:zryland 21L,.02
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Notary Public State o t Large : ~ . : , . ; `
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My Commission e~cpires__ - ~_1 `I 7 f-- ' ~ ~'v . _ -
(Tu be ezrcuted in duplicate anJ original filed wilh Clerk Circuft Court..an~.duplkate with Tax Assessor)
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~,~~213 ~t,~F 69~
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