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Declaration ot Domicile and Citizenship
TO THE STATE AND C~UNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that 1 am filing this day in accordance and
in conforr.tity with Chapter 222, Section 222.17, Florida Statutes.
1 was formerly a legal resident of ____~R~~ ~U•
(City) (State)
4701 DSrwOOd Dr. . However 1 have chan ed m domitile
and 1 resided at - - - _ _ - - 9 Y
(Street and Number)
to and am and have been a bona fide resident of the State of Florida since _ Z~t~ _ day of
Novesber 68 180 Serenata Ct.
- 19---. and I reside at
(Street and Number)
FORt PIERCE, SAINT lUC1E COUNTY, FLORIDA ~
and this statement is to be taken as my declaration of citizenship, actual legaf residence and domicile in the State of Florida.
(Insert here any pertinent facis, such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
FILING FOR HOMESTEAD PURPOSBS
F~~ED AND RECOROED'
- $T. I.UC~E ~ OUhTF : ~LA•
ti. _ . •
- 1 43U9
'68 FEg 12 PM ~ : 16
. ~
~;~c;__~ ~°0?TR ~URT
CLERK CIRCUIT C
I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiGle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ,'7 ~ i' ~
/
.
: 3. -
: , (Name)
. RICHARD A. GRANDB
~
` ~ . ' ^ ,~~i,
:'1 ~ y , . ' : . ~
, • ~ ? ~ ~ (Address)
' : - - . = 12th FEBRUARY 68
. bw4rn .!o ~d~subscribed before me this day of , 19 .
; .
• • r .
. . .
•RO~R S
~'C!~'t CU COURT _ Notary Public
By D.C. My Commission expires
(To be execu ed in dupliate and original ~iled with Clerk Grcuit Court, and duplicate with Tax Assesso~.)
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