HomeMy WebLinkAbout0935 De~l~ration ofi Domici~~ anc~ Ci~i~en~i~ip
2ss~so
~ru ~~~i~~ sTn~r~: nn~t~ c•oun~~ti~ •i~nx nss~:ssott.
sT, i.UCIE COUN7'Y, r•LO~z~ut~:
Tl~is is n~y circlaration uf Domicile and ('itircnshi~~ in thc Sl:itr of ~lorida lhat !~im filin~; this day in
accor~ancc, and in conformity ~vith Scrti~n ~2?.17. }=lorida Staiutes.
1 was fonncrly a lcgal residcnt of _ I~~~-~,sL[~K and 1
(CiIY~ (Statc)
resided at ~ ~ .~iowever, I tiave changed my~ d~micile to
(Street and Numbrr) -
and am and have txen a bona fide resident of the State of rlorida since JviVC' _-day ot'
19_Z..~, and 1 residc at 9~~ £"~f o
~ (Street and Number)
( ~`j ~ C ~ , ~ y . St . Luc ie County, Florida,
c
and this statement is to be taken as my declaration of citizensliip, actual tegal residence and domicile in the State
of Florida.
(tnse~t here any pcrtinent facts, such u sale of pruprrty or business, or relinquishment of empioyment at former
domicile~ remoral ot family to new domicile, purchase ot home, e1c.)
~'E ~ l 1V " C LI i,~ c-~/2 z'/1/ !/t,, S e tJ o v~
~
258'780
F1LFD AN^ RECOROFO
ST. ~UCIE COUNTY F~A.
RCC"t~i %'l~?TRAS
ciEF~t c~~;,u~; couaT
RFCORG YE~ ~!E4~,_..,.,:.~~
,1~.13 10 3s AN'73 ~
~
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t
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; I FURTtIER CERTlFY thst I w~il! rcgistcr at my local address when the registration'books reopen, and
~ comply with all other requiremcnts of a Irgal resident of this State.
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~ I FURTHER CERTIFY that 1 have no intention to return to my former domicile, and 1 intend to remain in
~
~ St. Lucie
' - - , , County,
; Florida,,permancntly. lc"~~
! •.~•L~.~ • - ~
. I (NameJ -
- ~ , I t~ ` • ~-__JL~~__+~J[-~/~ C.- /G'/'
,'t ~ , ' (Address)
, '
-.,~$wnrn-to an~u~scribcd bcfarr mr this -~3_-- da~• of •
' -Z~~~~ A.I). 19~-3.
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ROGER POITRAS, CLERK OF CIRCUIT COURT -
---i~~,kasx f:.~x:xxxax~s.x.xs~ta;x
B " Ueputv C.lc~rk
~ ~ty.~E~x.~i~ir~mac~ai~~x - -
~
_ (To hc cxrcutcJ iu Jupli:.~~r and on; ~n.0 fdrd «ilf~ r'Icrk l"ucuit C'outt.:~nJ duplic:~lr ~~itb "L~~ A..rtsor)
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: s°oox 216 rn6E 935
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