HomeMy WebLinkAbout1468 ~ecl~r~iion of Dornici~e ~nd C~~iz~r~~hip
~ro Trit: sTn~~t: n~vn c~out~~~~~ ~~nx nss~~~soK,
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`-_-.---~__COUI~TY, I~LOkII)A: ~
'Il~is is my drrlar,ttion of polnirilc a~ul ('itizcnship in thc Statc oT ~lorida ihat l am liling ihis day in ;
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.+ccordancr, :utd in conformit~~ ~vith Scction ~22.17. l~torida Statutcs. ~ I
I was forn~crl !c ~,it residrnt of ~Ar~~TOW/1~ • v• '
Y ~ ~ . - , and I
M E6~~t ~C DR ~ ~C «~~y~. ~5~.«,
resided at _ However, I have changed my domicile to
• ~ (Street and PSumber)
and am and have txcn a bona tidc resident of ti~c State of Florida since l~ day ot'
now -
_ , 19~, and 1/reside at S~~~Z yE
. (Str~cet artd Number)
ST• ~.VCt E , _ St. I.u~ie - _ _ Cvunty, Florit3~, -
(c~erl ~
and this statement is to be taken as my declaration of citizenship, actual legat residene~ and domieilc in the State -
of Florida.
(lnxcrt bere any F.rrtinent tacts, sucA u sale of propcrty or business, w telinquishmcM of employment at former
domicile, removal ot family to new domicile~ purchase of home. etc.)
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Entering children in school:
~~/d siE'PN~~~S o
A; P ~ .lT~ L ~ T E,PIS/ '
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sriiu°c+E couMTY
ROCf R PpITRAS ~ ~
CLERx Gl+iCUtT COltRt
RECORn vEa~~iED...,,~,~
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_ _ _ -~-~.~8 AM-'73--------- ~
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1 FURTHER CFRTIFY that I will register at my local address when the registration books rcopen, and ~I
comply with all other requirements of a Icgal rrsident of this State. . ~
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I FURTHER CERTIFY that I l~ave. ~io intcntion to return to my fornier domicile, and I intend to remain in
S~'. l. E,~~~' St . Lucie .
, , County, `
Florida, pcrniancntly. (c~rr~
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Svg6~P~~•~~'~`a~c~-se?li~A:nticcai ~cforc ine ti~i; - -I~-
:-~,h . day of
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- = • ~ - A. u. ~ ? 3 ~
, .-~e?.
R~ .~~I~;S, CI~RK CIRCUIT COURT ;
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- _ ej~zar__y C] er~ Beott218
(~lu bc rtceuli•~i in JnpGrat.r .u~d ~~ti~•n~.~l iifrJ «ilt~ ['irr~. ('irruil ('~rutl. aaJ ~leqrJiiatr r•ith Ta~ A>scstor)
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