HomeMy WebLinkAbout0019 , D~cla~atio~ of Domicile and Citl=~nship
TO THE STATE AND COUNTY TAX AS:,ESSOR, . ~j~~p~
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Sl. IUCiE COUNTY, FLORIDA:
This is my declaration oF Domicile and Citizenship in the State of Florida that I am filing this day in ac4ordsnte and
in conformity with Chapter 222, Section 222.17, Florida Statutes.
I was formerly a legal resident of _ . _ _ _B~=nl~ _ ~ew YorY _
- (City) (State)
and I resided at 64 TraC~! Str@ot _ _ However I have changed my domitile
(Street and Number) ~
to and am and have been a bona fide ~esident of the State of Florida since ____4th _ _ _ day of
Dn~is
_ Y!?]~ch _ ~9
7~, and 1 reside at Rt. _ 3~ EZ 451 ~ l[eddle Brook Dair~
~ (Street and Number)
FORT PIERCE, SAINT LUC{E COUNTY, FLORIDA
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Flotida.
(Inse~t here any pertinent facts, such as sale of propeny or business, or relinquishme~t of emptoyment
at former domicile, removal of family to new domicile, purchase of home, etc.)
3COTT GRA`TES Age 11
SANDRA aBAYES Age 9
CHERYL aRAVES Age 8
. ~T.
WW~~C0111IIT1?~,
JAI~ES GR.AVTsS JR . Age 6 itoaER raitit~~ ~
~ CLERK C1ttCVIT pO~Rt ~
R[EORD YEFi~ifEO
RESIDENC~ A2~D ENTERING CHILDREN IN SCHOOZ ~S ~72 ~
~26682
;
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! -
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I FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
! FURTHER CERTIFY that I have no intention to return to my former domicjle, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. ~
! ' ,r~.
~ JAMES R. GRAYES
~~s~t~:7r,,,, . -
(Name)
_ : 3 n = -
L
. t . . ~ ` .
' i ~
~ _ _ ~ ~ • - Rt. 3, Bz 45~ , Da~i• lieddle BrooY
~ ~ , , _ (Address) De11`~~ 1't. Piette~
~ ; ~~i
: ~ • r, l~loridet 33450
- .
':;~~.tp,a++d siS~tribed before me this 4th day of APril ~ 19 72
~ ~ if~tti~ i ,
ROGER POITRAS
CIRCUIT COURT Notary Public
By D.C. My Commission expires
(To b~ ~x~cut~d in dupliuh and oriyinal fil~d witb qKlc Graiit Cou~t, snd dupliu» with Tax Ass~sso~.)
~ ,3 ~2~1 ~ 19
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