HomeMy WebLinkAbout0561 . Ur:c{~~r~~~ic:i~ uf r~c;~ic:i1~ ~:tt:i Ci:i~:c:~z:.lyi~
1 U 11 iC STnI L- nNU CUUNIY Tnx n;SLS:~OR, 25~~.y~
?
Sl. LUCIE COUNTY, FLORIDA:
, This is my declaration of Domicile and Citizenship in thQ State of Florida that 1 am filing this day in acco~dance and
in conformity with Chapte~ ?22, Scclion 222.17, Florida Statutcs. . ~
1 was fo~me~ly a legai ~esident of • ~~-P 1~-«'
- (City) (State)
' f~ . •
'
and 1 resided at _ . However 1 have changed my domiCile
• ' (Streef and Number) •
to and am and have bee~ a bo~a fide ~esident of the State of F(orida since ~ day of
,y~ .
, 191,L, and 1 reside 'at e K~`'`~-~ «
• (Street a~d Number)
; _ . .
FOR? PIERCE, SAINT LUCIE COUNTY, FLORIDA ~ ~ ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
(Inse~t here any pertinent fads. such as sale of property or business, or relinquishment of employment
at former domicile, removal of family to new domicile, purchase of home, etc.)
- Entering children in school : ~
~ - . ~~Pi~O~R ~i l~~n.~ ~Ar-e~~ •
' ~ .
- _ ~ . - =~~uci~°c~u ~ ~ . . -
. aoa~R po~~
' • - ~ - _ ~6R0 YER
f
t~0 ~URt
i - ~ Z! .
. . ~
2s2~z -
1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal ~esident of this State.
1 FURTHER CERTIFY that I have no intention to return to my former domitile, and 1 intend to remain in FOR7
PIERCE, SAINT LUCIE COUNTY, FLORI~A, permanenfly. ' G~ja/QEsT
~~C 3. - ' '
,,,~~~~~~N ~ . . . • ~
' ~ : ~ s
' C, ~ . ~ 9; , • ame)
•
~ ~
~ : ' a : ;,;::~~/o : ? . -
~ . : _ `~-+'`d~ ~ Q
' ' G : 9 ~~.~C.~CcKS ~.r.,.~ ~df .i~. "
- ' m~ ' r " (Address)
- . _
, ~ • ~ • .
` y~..~V,~.
.,C I •~~~~N~~ s ~l . .
'',.~+F` C~•~~..`' ~ / •
~~'~;Mip?n.1o''bnd subscribed before e this day of , 19.~~
. .
ROG~R POITRAS
CLERK CIRCUIT COURT _ Notary Public
.
~y D.C. My Commission cxpires
_ ~~~~~3 ~ 5~0 .
(To bo oxocutad an duplicalo and ••~~nal (iled wilh Clerk Circuit Cou~t, and duplicato with Tax Assossor.)
4
' _ ' _ _ _ _ ' ' . ' ' ' _