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Decla~ation ot Domiafl• a~d Citisenship
. ~~~~5
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FLORIOA:
ThI: is my declaration of Oomicile a~d Citizenship in ths Stats of Ftorida that 1 am filin~ thit day in sooordano~ and
in oonformity with Chapter 222, Ssction 222.17, Florida Statutes.
1 was formerly a Isgal rosident of I~SwiCh MaS3• -
(~ity) (Staf~)
and I rosidsd at 118 Little Neck Road my domidk
(Sheet and Number)
ro and am end have been a bona fide resideM of the State of Florida ainoe lst ~y
November 68 105 Maule Ave.
, 19 , and I roside at ,
(Street and Number)
~ORT ~ SAINT LUCIE COUN?Y, PLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residenos a~d domidle in the State of Hotlda.
pnsert here any pertinent facts, such as aale of property or bu:iness, or relinquishment of employment
at fwmer domicile, renwval of family to new domicile, purchsse of home, etc.) ~
F~~~ AND RECOR
Establishing res idence ST• LUCIE COUNTY. FLA.
R~CORb VERIFlEp .
8ntering Stephen in the ~th grade ~ ~ 1~'1 "
~8 ~ ~&Q$ :
't Karen in the 7th grade • ~ ~
ROGER Pp~TRqg h%~
Paul in the 6th grade ~~RK CIRCUIT COtlRT:
1 FURTFIER GERTIFY that i will aomply with all ott~er rec~ri~err~ent: of a le~al rosident of thi: State.
I FURTHER CERTIFY that I have no inteMion to return to my former domidle, and I intend to remain in FORT
PIERCE, SAINT LUCIE C~OUNTY, FLORIDA, permanently.
. . (Name)
Grady C. Fitzpatrick
..~,:';~"'c.,
+ ~J 1 1 - ri'' .
~ -
~ ~ ~ ~ • (/WdfeSS~
- - . `
i~~>~~ ~ November 68
5wcin:i`p,~td before me this lst day of , 19 .
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. _ • . , .
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CIRCWT COURT Notary Pubiic ~
8y D.C. My Commission expi~es
(To b~ ~oaa/~d in dvpNeah and ori~in~! Hl~d wilb Cl~k Gra~if Coue~, snd dupiic~h wilb Tax As~era
~ ~ ~ 174 PAGE 7~5
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