HomeMy WebLinkAbout0731 ~ / .
tic ~ i~~k Slntt. nrs[~ c.c~ur.~t~• ir~.:~. r,•
:,1. IUCIC CUt1NlY, r~o~:iun: 258642
Tl~is is rny drelaration o( Domicile a~d Citizenship in the State of Flo~id.~ thal 1 am (il~ng Ihis day in accardoncQ ane!
;n con(ormity with Cha~1~r 222, Sedion ?22.17, Florida Statutes. . ~ .
1 was forme~) a Icc al ~csident of w a~b "r' ~~~7 ~ -
Y J ~
~ ~.3 f~l ~~l C r'S i ,~t ~ ~ (City) ~ (S1atc) .
end t resided at ~ ~ . However I have changed my domicile
• ' (St~eet and Number) •
. - . . 3u~~ ~ )l3
to and am and have been a bona tide resident of Ihe State of Florida since day of
,
~ ~ , 19 , and 1 ~eside 'at ' ~ ~ s W • V ~i r°~a a U ' ~ '
• (Street a~d Number) ~
~ ~
FORT PIERCE, SAINT LUCIE COUNTY, FLORIDA ' ~
and this statement is to be taken as my declaration of citizenship. actual legal reside~ce and domicile in the State of Flo~ida.
(Insert here any pertinent facts, such as sale of propcrly or business, or relinquishment of employment
at tormer domicile, removal of family to new domicile, purchase of home, etc.) . ~
Applying~ for Hoinestead . , ' :
- Entering children in school : ~~n ~h ~ I a - 9~ . . - - • `
- . . ~Q~r'. G/ Q S/ f-h .
' ~;~au. - ~.~f~ ' - .
- - . . . " Sa~ n al ro~ -3 . . ~ x
• . - f E4 Ait 0 R~~T R 1~~, • -
- - - f ~~iJ~IE ~0 Y
~ ~ ' ~ qQGER ~0!TRA~
• • ~ ' ~ CLERK G.KCUii. eol~R~ L ;
~ ~ . ~ RECORJ YEk~E?EO~~ ~
~ _ •
; • - _ . - ~ ,Iw,1 ~ 2 ks PM.'13 - .
` ~ . 258642 .
~ • . ~ • ~ - - -
~ ~ ~ " .
5
~
~ I fURTHER CERTIFY that I will comply with al) ofher requiremenfs of a legal resident of this State.
~ • .
I FURTHER CERTIFY that 1 have no intention to return to my forme~ domic,ile, and I intend t remain in FORT
PlEP,CE, SAINt LUCIE COUNTY, FLORIDA, permanently. '
.
C . .
~ .~`'Q
GV tT...., OG'•• , ~ ~ . -
~ :~V~;~yJV~~fI(~G~~~= ' . (Name) ~chas-L ~/ousPho/dP,~
~ -fl ~aty., ~t ~~u = ~ _ . ~ • ' f
~ ' ' 'l ~ S c~ I~~~sv~ ~
i ;~•;~i ~ ~ • ~
= . (Actdress) . -
~ - ~ , .
' ~ U r••... ' ~
~xz ~ ^.1 t~` .
rr ' ~j v • ~~S .
. -f~!!~.. C • .
s~ .•~t...t.,
Swom to and subscribed before me this ~ day of , 19~ -
~ . . j' .
~ • ~
ROGCR POITRAS
CLEI:IC CIRCUIT COUP.T Notary Public
~
.
~
~ ~ y ~ D.C. My Commission cr.pires
~ AV~i~ V~r rt V` •
et~ - . _ _ . ' _ _
~ (To be axoc~ted :in du~~licale and ~-•~nal (ilecl wilh Clerk Circuit Couil, anil ciu~~liwlo wilh Tax Assossor.)
' ~ -
~ ' .
~
~
~ ~
~ . ' ~ ~ ; :
` ~P ~ ~ _ ; ~ r~-~' ~~r~
s.r~,.__.>~,~.. ~.._._+__K.._ ~x~