HomeMy WebLinkAbout2589 _ .
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•ro ~~i~~: STATI: AI~'U cou;~~r~~ ~~~~x nssl:sso~t, ~
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ST. LUCIE __CpUti'TY; I~LOhIDA: ~ ~ ~ ~
This is my drelaratioii of Uomicilc and Citizcnshi~~ in thc Statc o[ }~lorid.~ that 1 am (iling this day in
accordancc, anJ in confonnity ~vith Scclioii 222.17, rlorida Statutcs. ,
I was tornicrly a Icgal residcnt of ~L t'~~~rd~ .~C~ J~~S~ ~ and I
_ _ - ~ (citr) istate)
resided at R/ ~~m- ~e~n.s Q,o~.s_ ~1~.,~-~iq ~o~ A , Ho~vever, I have chan~;ed my domicilc to
~ (Stteel and I~umber)
and am and ita~•c been a bona fide resident of the St:~te of I~lorida since day of
~lL~~ , 192~-, and I residc at / ~,3 1gi2oQdU/~c~ ~Sf- ~U~2t St ~~Ci~
(Strcet and Number)
P2T ~f- 7~S~~tGi~~ . ~T L.UGIE Cou:~ty, Florida,
- (ca~r) .
and this statement is to be taken as my declaration of citizensliip, actual legal residence and domicile in the State
of Florida. ~ -
(Inseri Aete sny perlinent facis, such u sale ot propctty or busineu. or relinquishment ot employment at tormer
domic~le. tcmoral of familr to new domicile. purchase of home. etc.)
~ ~ . .
Applying for homestead : . . _ . . .
~ Entering children in school : 7~~n ~~~2 ~'nC~ ./t.S-s~C~'
Othe r : ~ ~ ~ ~ _ -
' - i11E0 A~tA RfCO,iDEO ~
~ ~ ' ST. lUClf :0ltMTY f~, ~ -
; . RflC~F ~O~rR~S ~
~IEP.K G; :.UtT CQURt
i - ~`~~kr, yfc ~r~E[ - • • ' -
~ - - A~c 21 2 ai PH '~3 -
e -
26~g~ .
I I~[JRT1irR CERTIFY that 1 will register at my local adclress when the re~istr~tion bool:s reopen, and
comply vrith all other rcquirements of a le~al resident of this State.
I FURTtiGR CERTIrY that I have no intcntion to tcturn to my former domicile, ancl I intcncf to remain in
~ ~G~T St ~u St~. Lucie County,
~ Ftorida, permancntly. (c~~r) ~ ' -
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t:~~1T' .C ,
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- .^OG;~` (Namc)
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- ~ • ~e~' ~ j- O ~ ~ (Addres+)
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r. ~1• z t
~ ~ 2~~ S~ ` . .
~ ~wciu~~d„su~i{cRt~cl brforc n:c tl~is _ ~ ~~day of
% ' ' = '1~":
~ ~ ~~t -
- ' A.I). 19._ ~_3._.
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}:~~~L'?: 1'OiTi~i~~ ~ C1_1:1:1: CTi:CIIIT COUE:7.' u~
BG~K PACE ~5~~ ,
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