HomeMy WebLinkAbout2255 ror~n h. T. 1r80f-D-iWY-.1-9~i-67) ~
~ DeclQration of Domicile and Citisenship
TO THE STATE AND COUNTY TAX ASSESSOR.
COUN'1'Y. FLOftIDA :
, }
Thia is my declsra?tioa oi Domicile and Citisenahip in the 3tate of FloridA th~?t I at~? fllin~ thia dwy in
~
~?ccordance. aud 'w coniormity Nrith Clupter ?.22, Sectio~ 222.17. Floridu Ststutea._ ~
,
I was formerly a leQal reaident oi_..H~r:t~x11]e.._...-~-------.-----•--- .Sst~th__~~~'Q].~....------ - :
caa?~ csaa~
and I reaided at__11.Q..I~kn~cieY-~il~.--~S~~n~•--NQm:e .at_.Be~Arc~iowever. I have chan~d my damicile
(StrMt aad NumMr)
w~xd~~.'~X181~1t1l1~Ckl~lNC:~l4UClF94?1~A[RJ4J~ the State of Florida einee--~at----- day oi '
19_.__.. and I reeide a~.._~? 9-1_.PO~°--Avenu~_---------
_ Janusry ~ -
- (Sts~t and Nnmb~r)
Fort Learen~rth Kanaaa _.~~r~~iq~~,,
-
ccai~rr ~
and this atatement is to be talcen as my declaration oi citis8nship. actusl k~si residence and domicile in
the State oi Florids.
(Inart h~r~ W v~etia~nt i~ets. weh u~al~ ot~ro~attAa~ o~
hoa~a~. ~irte.l ~uiahmfnt a~ Nw~lorm~aE at
torm~r domieiN. riaeotrl ot iamib to ar? dom D
I am in the U. S. Ara~, and upon retire~ent, plan to live in the .
state of Florida. I haoe purchased lot # 6 in block 2485 at Port St.
Luc;e from the General Development Corp. In .?uly, of this yea~r,~I.
r~y.
plan to visit the county court house in Port St Lucie and register
for voting and for campleting a~v ather iegal docu~nenta required for
~
_ i
citizenship in the state of Floriaa. -
2~1_sss ~
.
,r ~
=~~~4f$~~'~~
QaCER ~01TRA~ ~
RE C~p1El0 YERIPIEO...+...~~ i
~IL 7 31 ~
, ~ f t~
,
I Fi1RTHE~i CEI~TIFY that I will re~iater at my local address when the re~3stntion booka reopen,
and comply witli all otber requireaneuta of a le~l reaident ot this 3tate.
live at
Y FUKTHE~t CEATIFY tLat I have ao intention to ~Cp my former domicale, snd I intend to reauun
~-~-0~,_~_~~~~~rmanent address) , St ,j,,u~Cle _ County Flarida.
. tC~b) - - - ~ , f, '
Pei~~n~]X:::., r~
. . CARLVIN J GRIGGS ~<<~~ ~ z{-Y- ~
(Nam~) .
- 319-~ Pope Ave Ft. Leavern+o h Kansas ~
• . • . _ ~
Sworn~W. ~ i =.bed before me tl~is~
~_day o! (Addr.a~) _
. .
~ A. D. 19~'.:.._.
, _.v
~ " ~ t G L
- I
NoQl~publk Bt~t~ ~.~lorid~ .t e~~ 193 22 '
- z . , , - ~ 53 ~
~iy Commisaion expirea..._ ~ ~ ` /~~..~.~._.1 ' i;
(To b~ ex~eat~d ~ dwlfab ~ad ~dRia~l Al~d wit1~ (~rk Cl~enlt Co»rR swA 8uD11ert~ witl T~[ Ai~or)