HomeMy WebLinkAbout2605 Decla~ation ot Dotnicile a~d Citisenship ~
TO THE STATE ANO COUNTY TAX ASSESSOR, 14~20
Sl. lUC1E COUNTY, FLORIOA: ~
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This is my declaration of Domicile and Cititenship in the Sta~e of Florida that I am fili~g this day in actordance and ;
in conformity with Chapter 222, Section 222.17, Florida Statutes.
;
1 was formerly a legal resident of _____CoQi~ue~ Lpn~_Island _ New York
(Ciry) (State) -
and 1 resided at _286_~_Ig~~v~1]Ue
_ - _ _ _ _ . However 1 have changed my domiGile
(Sfreet and Number)
ro and am and have been a hona fide resident of the State of Florida since ___~2 day of
_ September , 19 66 , and I reside ar 51 Wlispering Creek ~illage
(Street and Number)
FORT PIERCE, SAINT LUCIE tOUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legat residence and domicile in the State of Florida. ~
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employment '
at former domicils, removal of family to new domicile, purchase of home, etc.)
8stablishing residence FtlEO ANO R
ST. ~UCIE COUN~~,
RECORD VERIF ED ~
, `'~l~~~G~t;.~~.[..~
ss ocr ~4 ~ : 2Z
~20
~ Fo~~~ POITRAS
CLFRK CIRCUlT COURT
k ! FUR7HER CERTIFY that 1 wil) comply with al! other requirements of a lega) reaident of this State.
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; I FURTHER CERTIFY that I have no intention to return to my former domitile, and 1 intend to remain in FORT
~ .
PIER~E~_,$/{~IN.~,LU~CIE COUNTY, FLORIDA, permanently.
; • ~
= rJ y~~'• • '
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~ J . ' :.-1 ^ ~
~ . ~ ; ~ ~ (Name)
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` Nazel Graves
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~ ~ ' : (Address)
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Sworn to and subscribed before me this , 18 day of _ ~tober ~ 19 66
ROGER POITRAS
CLERK Ct UtT COURT Notary Public
BY D.C. My Commission expires
(To b~ ~xscw~d in dupliuts and o~sinal ~iled with Clerlc Circuit Court, snd dupticst~ with Tax Ass~ssor.)
800K 15 / PAGE ~Q4
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