HomeMy WebLinkAbout2682 Declaratton of Domicile and Citizenship
1s5155
TO THE STATE ANO COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, fIORIDA:
This is my declaration of Oomicile and Citizenship in the State of Florida that I am filing this day in accordance and
in conformiy with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of ___Batavia _ _____A__. New York _ ~
(~;ty) (State)
,
2750 Pearl Street f
and I resided at . However 1 have changed my ciomicjle i
(Strcet and Number)
to and am and have been a bona fide resident of the State of Florida since __~IId__- _ day of ~
p~bruary 68 3201 Boston Ave., ~
- 19----, and I reside at
(Street and Number)
fORT PIERCE, SAINT LUCIE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Insert here any pertinent fads, such as sale of property or business, or relinquishment of employme~t
at former domicile, removai of family to new domicile, purchase of home, etc.)
EstabliShing residence FILED AND RECORDED
L'J~:~ C.~U~STY, FL:~.
_ ! ~ . . . ~ ~ ~ ~.~65155
I3 AM ' . : I I
• _ ,.i::N.. ;
Gt_~~'K ~iRCUtT C~URT
I
i ~
(
1 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, SAIf~:l11ClE COUNTY, FLORIDA, permanently.
:i~t:~so t~.•t;~:
~ ~ . ~
~
~ ~ . ~'G'
~
1'~" ame)
_
~ s ' ' ~ ? = ^ " Floyd Grace
. . :
-G~ .
~ . ~ ' ~ ~ _ ` (Add ress)
i
v 13th March 68 ~
Sworn to and subscribed before me this day of , 19 . ~
t
~
~
~
ROGER POITRAS ~
~
LERK CIRCUIT OURT Notary Public ~
~ ~
gy ~r~- D.C. My Commission expires ~
i
i
;
(To bs exscut~d in dupliuro and oriQinal filed with CIKk Grwit Court, and duplicats with Tax Ass~stor.)
dO~K ~ / U FACC ~V ~O
-
~ = ' ~ ~
~ ~
~ = - - ~ ~ ~
~ ~ :