HomeMy WebLinkAbout1670Declaration df Uor><-ticile and C:tiz~rship 3~RK ~~ PA~F ~n 1
' ~ ST, ! UCIE C.'iJNTY, ALA.
TU T'rIE STATE ANll COUNTi' 'I:~ AS5ES5(?R,
,T. LUCIE COUNTY, FI.OftIDA:
This is my declaration of Domicile and Citizenship in the State of Florida ghat I am flling this dey In accordance
and in conformity with Chapter 222, Section 222.17, Florida 3tntutes. '
~1 Paso ~eXt~ s _
I was formerly a legal resident of State
[City]
and I restded at 3040 B Hero Ave. Ft. B11A8 However, I have changed my domicile
(Street and Number]
• 4th day of
to and am and have been a bona fide resident of the State of Florida since
December _ 1<9 g? ana I reside at Gen. Del.
• [Street and Number]
FORT PIERCE, SAINT LUCIE COUNTY. FLORIDA,
and this statement is to be taken as my declaration of citizenship, actual legal residence anal domicile In the State of Florida.
t
[Insert here any pertinent facts, suet as sale of property or bus[ness, or relinquishment of employment
at former. domicile, remo~•al of family to ne~~ domicile purchase of home, etc•]
~;stablishing residency
Fsnterinb Charles L. Htlghlett in High school
11C~93~
. EEO AND RE~RD~00~
~,:;~..•ctir.~~ : ~N M 1:33
. c. ,.s;; ~«•••w ~ 1962 DEC "5 P
_.4r .. ~ ~, "_ ~~. T RAS CIERKU
.,r, ~ ~' `.'~ p, ~ ~GER P01 ~,~ .l OR p
,`~_,.. ~;.~: A tUC1E COON ~ F-
' -~ • is ~`' • . 1 • ~
• ••,.h.
n V
..- .Ut. ~~~'~'
I FURTHER CERTIFY that I will register at my local address when the registration b~oks reopen, and comply
with all other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
FORT PIERCE, SAINT LUCIE COUNT'], FLORIDA, permanently. ,y-'
"K4
I.sYlC~O . $hl~tt
. [Address]
. - > ,;-
Sworn to anri subscribed before me this. 5th ~ '"->~~• ~601C18b9T 19 g2
Ir~ 5: ..a~ ~ 'C-
CLERK Cl "UlT C~OU~R~T` 'yam;g U~,,s} ~ ~,*~:.ry, Notary Public
. r , <y l = a.- y.
(Tc be executed la dupiicxtg.a,nsl olltlnal filed evitY• r~ ;e~~~~wr+d daplicste sv1Yh Tax Assessor]