HomeMy WebLinkAbout0216 Declaration ot Domicile and Citizenship i46128
TO THE STATE AND COUNTY TAX ASSESSOR, ,
Sl. WCIE COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this dsy in actorda~oe and
in conformity with Chapter 222, Section 222.17, F~orida Statutes.
1 was fo~merly a legal resident of _ LIVINsSTON N• J•
• (City) (State)
.and 1 resided at 35 S/ MitCh! 11 Ave. _~,,,~ever 1 have changed my domitile
(Street and Number)
to and am and have been a bona fide resident of the St~te of Florida since __-_15th _ day of
u e , 19 66, and 1 ~eside a~ ~ ~en. Deliverq
(Street and Number)
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actuat legal residence and domicile in the State of Horida.
(Insert here any ,pertinent facts, such as sale of property or business, or relinquishme~t of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
i46i28 ~
Fi~o ~NO REC~R~~~
ST. LUCIE COUNTY. RI.A:=
RECORD VERIFIEO
GtiL~.I~
- '66 JUN 15 AM {0: 13
r~OGEP. ?~OITRAS
CLERK CIRCUIT COURT
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I FURTHER CER7IFY that 1 will comply with all other requirementa of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiG~e, and I intend to ~emain in FORT
PIERCE, SAINT IUCIE COUNTY, FLORIDA, permanently_
,
`~~11lii111ill;j~t ~ •
~`U~~ . y O - _ / ~ . ~ t ...s
:``.Q. f'"~W ~ (Name'
~ f~'J ~ Grammig, R chard A.
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~,~s t . t°-~ : ~ ~ (Address)
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,,'I~~` ~~~M~sM~~.~ 1 ~
~'~f~~~~i¢,~~i td and subxribed before me this 15th day of June ~ ~q 66
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ROGER POITRAS
' CLERK CIRC COURT Notary Public
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By ~.C. My Commiuion expires
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(To b~ ~xscuf~' dupliute and original filed whh Clerk Grcuit Court, snd dupliuts with Tax Ass~ssor.)
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