HomeMy WebLinkAbout0512 • . . . . . ~
1C~ 11i1 STA1t. /1NO c:(~Ut~ll' In~. ,::,•;.~f;,
Sl. LUCIE CUUNIY, i~lOE:IUl~: 2~03
This is my declaration o( t)omicilc and Citiz~•nship in thc State of Florida that I am (iling tliis day in accordancU ancl
in con(ormily wi~li Cliap~~r 222, Section 222.17, Florida Statutes. . ~ .
1 was tormerly a Iegal ~esident ot ~ ? -
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1.y ~?ov~,•..~ C~-+- - . Howeve~ 1 have chan9ed my domiCile '
and 1 resided at _
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so and am and have bee~ a bona fide resident of the State of Florida since day of
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' . , 19._l_.Z, and 1 reside 'at ' y~0 / ~?J 4~~e-~ ~L`'wh Nhµ-'` • " -
• (Street and Number)
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FORT PIERCE, SAINT LUCIE COUNTY, fLORIDA '
end Ihis statement is to be taken as my declaration of citizenship, actual legal residence and domicile in ihe State of Florida.
(Insert here any pertinent facts. such as sale of property or business, or reli~quishment of employment
af former domicile, removal of family to new domicile; purchase of home, etc.) _ ~
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~ Entering chfldren in school : . ~ '
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- ; Sero 1^+ e ~ S f.e;.,uc~ vT- . 1tfC4~D i1EB~t~~fl~.~.~.~. . - . -
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~ I FURTHER CERTIFY that I will comply with all other requirements of a legal resident of ihis State.
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1 FURTHER CERTIFY that I have no intention to return to my former domiGle, and 1 infend to remain in fORT
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~ QIERCE, SAINT LUCIE COUNTY, FLORIDA, permanently. '
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~ . ' (Name) _ . '
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~ ~.,f, oti1;~p ~ scnbed before me this 1 day of - - , 19~
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ROGCR POITRAS ~
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~ CLEt21C CIRCUIY COURT No1ary Public
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~ ~ y \ D.C. My Commission expi~cs
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(To be oxeculed ,in cluplicale .ind ~••~nal (il~cl wilh Clerk Circuit Courf~ anJ du~~licalo with Tax Assossor.)
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