HomeMy WebLinkAbout1610 . ~}::G1.'it'~-i~i~i~~ Ut ~~i?1it:~~:: ilti:i ~:t:t::C:t1:;lii,~
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10 THE STAIE ANp CUUNiY T/1X /~;~SE.S'~•C~R. • ~ ~
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Sl. IUCiE COUNTY, FIORIDA: ~
This is my dccla?ation of Uomicilc and Citizenship in thc State of Flo~ida that 1 am filing this day in accordance and
in conto~mity with Chapter 222, Sectio~ 222.17, Flarida Statutes. . ~
I was formerly a legal resident of . S.~E~~c%' ~ /Y~° w Y~ 2/~
(City) (State) ~
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and 1 resided at ~G~~/~~~,E~v T~T - . Howeve~ 1 have changed my domiu~e
• ' (Sfreel and Number) • ~
to and am a~d have been a bona fide ~esident of the State of Florida sinte ~ . ° f~ T~day of
.~~c ~M,B 1e ° v - ~ ~/3 ~l- 7`v ~ s ~ ~ .4~ ~ ~
, 192-, and 1 ~eside ~at
- . . (Street a~d Number)
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FORT 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.
(Insert here ~a~y pertinent facts,. such as sale of property or business, or relinquishment of empfoyment
af former domicile, removal of family to new domicile, purchase of home, etc.) . ~
Applying, for Homestead _ . : ~ - ~
Entering children in school : ~
- J'v S e.~~ ~T- . ~s C~ i _ .
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~ . , ~ FILED AND RfCORdEO ~ ;
~ it ROCERC~d tRAS ~ ~ ~
• • • ' - CLERK Ct~CUtT COURT ~
~ - ' ' RECORD VERIFIED
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~ 1 FURTHER CERTIFY that 1 will comply with all other requirements of a legal resident of this State.
1 fURTHER CERTIFY that I have no intention to return to my former domic.ile, and I intend to remain in FORT
PIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. L-vuis - e M~s`~' ~
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~~.•~~~t~.~y~~ ~ . l
GV C ~(jp'~~, • (Name)
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n`:_ ~ ~ . ~ ; (Address) . • ~
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~ ' Swb~n to ancl subscribed before me this 3'8 day of , 19~ ~
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ROGER POITRAS ~
CLERK CIRCUIT COURT Notary Public ~
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dy D.C. My Commission cxpires ;
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(To be oxoculod ~n duplicato ~nd ~-•~nal filcJ wilh Clork Ci~cuit Court, a~:d duplicato with Tax Assoswr.)
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