HomeMy WebLinkAbout0875 .m _ . . ~ - ~ - - _ - _ _ ,.w _ _.~.a s„~,
De~laration ot ~omi~il~ anti Cig~zer~ship
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TO THE STATE AND COUNTY TAX ASSESSOR, ~.~~ti,~~ j~ ~
S~ . LUCIE COUNTY, FLORIDA: ~
This is my de5laration of ~omicile and Citizenship in the State of Floricla that I am filing ihis day in accordance and
in conformity wifh Chapter 222, Section 222.17, Florida Statutes_ ~
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! was formerly a legal residen! of _ 1~11UChUla _ _ _ _ FlOrlda _ _ #
(City) (Sfate) '
General Delivery
and I resided at _ - . - _ - - . Nowever I have chang~d my domiGile
(Street and Numoer)
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to and am and have been a bQna fide resident of the State of Florida since _ 1_. _ day of ~
July 65 318 N 17~h Street ~
- - - 19-- - , and I reside at - - i
(Street and Number) i
FORT PIERCE, SQINT LUCIE COUNi'Y, F10RlaA
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 facts, such as sale of property or business, or relinquishment of employment !
at former domicile, removal of fami~v to new domicile, purchase of hon~e, etc.)
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~stablishiQn residence F+~-~~ ~ND REC9RDED
'~'--~f~~~l- RecoEd._~ooK :
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: , '~s Jr~l~~ I 7 pM ; ' $ ;
. : . L~`~C~
~ ~ ~ ROG~:t CL`cr,K ~
- . _ ST. L.UCIc C~UNiY ~
J, ~ ~ ; ~:~c • FLG -~Clba ~ ' !
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1 FURTHER CERTIFY that I will comply with al) other requirements of a legal resideni af this State. ~
I FURTHER CERTtFY that I have no intention to return to my former domi~ile, and ! intend to remain in FORT
~ PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently.
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~ : Harvey Grant ~
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. . ~ , ` r (Address)
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..Sworn to and subscribed before me this ~ 17 day of _ January ~ 19 66
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E
k , ROGER POITRAS
CLERK CIR T COtJRT Notary Public
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By D.C. My Commission expires
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; (To be executed in dupticate and original filed with Clerk Circuit Court, and duplicate with Tax Assessor.)
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