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Declaration ot Domicil~ and Citisenship ~
~OUNTY TAX ASSESSOR ~S`'"~_ ~
TO THE STATE AND .
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51. WCIE ~OUNTY, FLORIDA:
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This is my declaration of Domicile a~d Citizenship in ths State of Florida that 1 am filinq this day In acoadanoe and
~n confo~mity with ~hapter 222, Section 222.17, Florida Statutss.
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I was fo~me~ly a legal resident of Warsa NeM Yer1c t
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and 1 residad at Brad Street . However 1 hsvs chanqed my dornkile
(Straet and Number)
to and am and have been a bona fide resident of the Stste of Florids since 23rd day of
Anqus~ ~ ~q 67 a~ ~ reside at 912 Crerfish Cc~urt~ Pn_~,. Piers~~ F1~,
(Stteet and Number)
FORT MERCE, SAtNT LUCIE COUNTY, RORIDA .
and this stateme~t is to be taken as my declaration of citizenship, actual le~al residence and domicil~ in the 5tate of Florida.
(Insert here any pertinent facts, such as sale of praperty or busineu, or relinquishment of employment
at former domicile, ~emoval of family to new domicile, purchase of home, etc.)
Da~id Graha~ entering first gradt
Che~y~ Grahu entering second grade
FILEO AND RECOROED ~ ;
' ST. LUCIE COUNTY. FIA. _ t
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~ '6T AIlG 29 AM 9 A~
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CLERK CIRCUIT COURT
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1 RIRTHER CERTIFY that I will aomply with all other requireme~ts of a lepal resident of fhis State. ~
r tum to m former domi 'le and I intend to remain in FORT ~
I FURTHER CERTIFY that 1 have no intention ro e y U. ~
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PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. _
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(Name) ~yra. Irlildred Grahas 5
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(Address) '
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Sworn to and suB3cribed before me this 29th day of AUguSt 19~. ~
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: C~ , ' " Notary Publ ic ~
~fi - , ~ I ~ ' D.C. My Commiu'wn expires ~
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`~d;~i! ~~wNd in du~cai~ ~n~ ai~inal Nl~d wid~ Cl~elc CMarh Cowt, and dvplieal~ wilb Tavc As~or.1
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167 966
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