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HomeMy WebLinkAbout2610 . ~ ~ « . . ' ~ r ~ ~ ~ rs . ' ,t ~ r r.` ~R _ r•! ' ~ v . ~ ~ ' ~ t ~.~'C:~.i~.:c c..~c~~ ~.l~c N...~ 4~:~ r 1~•.Ji:...• C:. i;.: .~~t.l. ~ 1.: .~i:~~_ . , ' `c , '1-O 7711; STn7'1; /1N1) ('OUt~7'1 7'I\a ASSI~S.,Oh, ' „ w ---ST. LUCT1; CUU1~'1'Y; 1'I~OI:IDA: ' '~,fj~~4• . . , . 'il~is is my dcclar.ilio~i of Damicilc aiul Citizcnshi~~ in lhc Stalc oC 1=lorid<< tl~at J am filin~ lhis day in accordancc, and i~~ conformity ~~~ith Scction 222.17, l~l~rida S1ah~tcs. , , ~ ` ] was formcrly a lc~al residcnt of , s~~~-°`~`-~- and I ~ . ~ • (c~~r) (s~~~~~ ~ residcd at ~~o'~_ ~ . I-lo~vcvcr, I h~vc chan~;cd my domicilc to ; ~ (Sltett and t~umber) ~ and am and havc bccn a Uona Cdc residcnt of thc Statc of rlo 'c ' c;t'~~~---~ ~ day of ; 19~, ~ and I residc at ~ ~ ~ ~ (St~cet and iQumbcr) j ST L_UGIF County, Clorida, (~~r) . ~ ancl tliis statement is to be taken as my deelaration of citizensl~ip, actual legal residence and domicile in the State of rlorida. ' • - (Insert 1?ere any perfinent tacts, such as sale of properly or business, or telinquisf?ment of rmployment at formet , domitilc~ removal of family to ne~v domicile. purcl~ase oi home, ett.) . : . • ~ . , . . . - - ~ - . - . . . ' • - • - ' ~ . APP1Ying for homestead : , ~ ~ . - ' . ~ . . . ; - , . _ Entering children in school . - . _ - . ~ 5- . . ~ . _ . - . . _ ~ : Other: ~ . - _ ~ . . . - ~ _ - . _ - . - . - . . _ _ ~ . : ~ - _ . : ~ . ~ . - - : , ; - ~ : - . ; - _ . - . . . _ _ f~ G Alt9 REC~¢ijp . ~ . - - - . . ~ - : it. li1CsE ~0~ L , . . . . - - .ROGE~- ?Gtt,~~; ~ . E ' . . . ~ . - - : • ' ~l$:~~~~ ~ . - ~ , ~ . - . - • . . _ ~ ' ~ . ~tECQRQ~~~1ftCfi. • • ' . - ~ . : ~ • . - • - . • ~ _ ' ~ . - " • - • . ~ ~ . - . - _ - - - - : - _ . . - - ~a 11. 3 s~.~!!'~3 . . _ : . - F ~ - - - - - . . . - . - - - - . . - . ~ . ~ ~ . - . ~ . _ . . ~ . • . . . . , , . . - - . _ - . . ' . . . • . - . i . : _ . - ~ : _ - - ~ _ ~ : - - : _ 2s2104~ ~ . : - - - ~ : I rURT11~R CERTIFY tl~at I will rcgistcr at my local address whcn thc rcgistration books rcopcn, and ~ comply with all othcr rcquircmcnts of a icbat residcnt oC this Statc. ~ . ~ ~ I rURTIICR CCRTIrY that I havc no intcnlion to~ rctunt to my. formcr dotnicilc, and I intcnd to rcmain in ~ , ~ St~.~ Lucie . - ~ , l(.~s~ , , , County, ~ ~ l~lorida, pcrm~qFntly. (a`y~ P . ~ . ~V 17.. `CO'•ry;~,~ ~ J ~ ~ . ~ ~ _'~;•:y~;~;',-~•~;G'f'j~'~.~= ~ , / ~ ~ .rw .J _ i~ _ (Name) 1 ~y.. ~1~~ .r:~ .~'••Q.~~ . . „ ~ : • _ ' ~ - : ~ ~ " ~~~t J~ . ~ ' ~ ~ i ~6GQ~ : ~ ~'r~ .1 y ~ ~ ~ , ^ , ~AdJress) ~ i . . ' ~ / -l~~ ~.•••'t ~ ?j ~ c~t n"4~i~ , ' ~i,Ml''~'~ bcforc mc il~is _ Z day of . ~ . . . _ ~ ~ ~ 73 ' ~ - /?.1). 19. ' . ~e i:C~:;i:)t OI'1'1:l~ CLi:~:l: CT]tCl1I' CnUI:7' ~ ~~~'2,~,~ PAGt~~ i. BI,~A _ ~ ± ~ ' ~-~s~s~,~~ ~ Cc.~ _ - • ~ ~ ~ ~ ~ ~ vu ~.9 s ~~r~"~ ~ -v.. _ s,,. . . . , . r ~ y