HomeMy WebLinkAbout0657 Declaration ot Qomicile a~d Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR,
Sl. LUCIE COUNTY, FIORIDA:
This is my declaration of Uom~cile and Citizenship i~ the State of Floride that 1 am fil*ng this day in accordance and
~n conformity with Chapte~ 2?2, Section 222.17, flo~ida Statutes.
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1 was formerly a legal resident of _~=~!~~e'-±~t~.~-
(City) (State)
and 1 resided at _ y~~ __'.C~~''~!~ However I have changed my domiCGle
' (Sireet and Numbe~)
ro and am e~d have been a bona fide resident of the State of Florida since ~T_ _ day of
~ , 19
~ C~ and I reside at _ _ _~S__ _ . _ _ _
(Street and Numb
FORT PIERCE, SAINT L CfE COUNTY, RORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flarida.
(Insert he~e any pertinent facts, such as sale of properry or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
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FIlEO ItMD RECOROED
ST. ~UCIE COUNTY ftA. ~
ROGf~ Pa~TR~S
CLERII C~RGUtT ~
RECORD YERtF1E0
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~ 1 FURTHER CERTIFY that 1 will comply with all other requirement: of a leyal resident of this State.
~ I FURTHER CERTIFY that I have no intention to return to m former domiGie, and 1 intend to remain in FORT
$ Y
~ P~ERCE, SAINT LUCIE COUNTY, FLORIDA, permanently_ Claude E~ Grizzell ~
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~ - ~ - ,
~ (N e)
~ Claude ~ Grizzell
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~ (Address)
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P, Sworn lc and syburibed before me this day of , 19 7~.
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~ , - Notary Public
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By ~ ~ ~.C. My ~ommission expires
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~ Re b~• ~ ~iqrdleplieat~ snd oei~inal ~i{~d with Cli~lc Grwit Court, ~nd dvpliuh with Tax Ass~sw?.1
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