HomeMy WebLinkAbout0922 D~claration of Domici~e and Citizer~sh~~
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ST. LUCIE_ ~~OUN7'Y, LORIUA:
Tliis is my ctccl:~ration of 1)omicilr ,~nd Citir.cn~hi~~ iit thc St:itr of 1~lorida th.lt 1 am filin~; thi~ cl~y i»
.~ccor~lar~cc, and in conformily with Srctic~n 22?.1 Florida Statutcs.
i was formerly a Irbal residcnt of _~~f'- a , ' ^ and 1
-~i•~--" (cit (state) -
residcd at ~ P~ . However, I have changed my domicile t~
(Sueet and Numbr~)
and and have been a buna Gde residrnt oF the Statc of Fbrida since ;
~ day of
~~l Si~i/~i°e~ -e- ~
, 19 and 1 residc at
(Street and Number)
p1 / 'l ~c~ ~ , St. Lucie County, Florida,
~c~~y~
anci this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(lnsett here any pertinent facis, such u sale ot pruperty or business, or relinquishment ot empfoyment at tormet
domicile. remova) of family to new domicile, purchsse ot home, rlc.)
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I FURTEiER CERTI~Y that I~vill reaister at my tocal address when the registration books reopen, and k
i comply with all athcr requiremrnts of a icgal resident af this State. ~
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~ I FURTHER CERTIFY that I l~ar•e no intention to return to my former domicile, and I intend to remain in ~
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~ Florida, permancntl «~~y~ ' ~ , Cotmty, ~
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e S~~o~n:t~U'~ir~~~su~gS¢~cd~bcforc mc this day of • '
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~ ~t~0 #i~1.fi~~LERK OF CI UIT COURT
-xxx~:a.;• x
; j;~ •'t~ e~uty Clerk 0 R
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(To Irr r~rcutcJ m duphi.di rnsl ur~t:~n ~l tdrd ~~i1h ~ Irrl. ll~ruil ('~~urt. anJ duplir,~rt• ~~~Ih 'fax A»rstur?
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