HomeMy WebLinkAbout0459 Declaration of Domicile and Citizenship
TU T}I1: STATI=. ANI) ('vUN1'1• ~~A~ nsst~ssok. 241855
St. Lucie ('UUN~I', f=LORIUA: -
Thi, i. my ~I~rlaration ut~ Uomiril~ :in~f ('itizrnshi~~ in thc Stat~ ol~ Florida thai l atn filing this day in
ac~oraaiic~, cuui in ront~~rmity with Srctiun ,,,.1'. Florid:i Statut~s.
1 ~vas tormcrly I~~;al r~~idrnt ut' Cincinntttti , _ - • - - ---0-hi0------- and I
~c;,~) ~s~a~r?
r~si~lcd _ 1561_ Knox StY'eet_ . Howrvcr, I havc ch:~nged my domicilc to
(Strrrt anJ Numhrr?
and am and iiavc l,~~n a bona ti~lr rrtiid~n[ c~f thc State ul E=lorida since ---~r~__- day ot
Nove~~ er_ . 1 72_ . an~i t r~;i~i~ .~c _ _ . .271~ S~ti~2.~~tr~.~~---
(Street and Number) ~
Tt• _ ~ierCS _ - • ~~~I,uci~- County. Florida,
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:ind this statrmcnt is to br takcn as my de~laration of ~itizenship, ~ctual legal residence and domicile in the State
of Ftorida.
(Incer. hrrr rnc prrUn.•nt i~cts, su~h a+,alr uf pr..prrt~ ur bucineu, or relinquichment ot rmploymrnl at furmrr
dumi:ilr. rcmu~~l uf family u~ nc~~ Junucilr, purcha~e u( homr. rtr.)
Entering children in~achool
FIIED ANC RECOROE~
ST.LUCIEr f~
jaAS`A ~
pdCE t
CIE~K :CUIt COURt
RFCOR:3 Yi L't i~0...~.-~~""
~y 13 9 2~ AN'7Z
j ~ - 241855
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I FURTHER CERTIf~Y thal 1 wip r<<~i.tcr at my loral a~ldress whrn the rcgistration books reopen, and
romply with all othrr rcq~~ir~m~nts of a Ir~~.it r~siacr~t oi ihis State.
l F=URTHER CERZ'IFY that I hucL n~~ intention ta r~turn to my tornier domicile, and 1 intend to remain in
~ ~t. ~ier~e- - _ - - - - S-t-•-Luc~~--~----------• Co~mty, :
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• I,illian Davia ~Lra b: rl
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'~yv6r ~ ~t~bsrrihed hefor~ me thi~ 1~ ei:iy nf
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~ _ / . . • ' - ~iQVe~nber- A. t~. 1 . ?2
~o-e~e~.t~~
~ - - Nutary Public Stale of {lonJa at Lar~.• -
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~ 111y C~mmission cx~ires ~<-R~~y- / S ~/~Z
~ (Tu br rrecutrJ ~n Juphr.~i1c enJ ~~n~;inal fdrJ Nith l'Irrk ('ireuit Court. and Juplicate Nith Tax Assessor) !
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