HomeMy WebLinkAbout2111 ~ Dec~~ratior~ Q~` t~or~ic~~~ anc~ Ci~i~~n~'~~~p
~~c~ ~rii~: s~~n-ri: nnn c~o~:~~r~~ ~rnx nssr.ssi~ii. 263821
St.Lucie
- COUh"i'Y, t~LOhIUA:
Tl~is is my dcclaratic~n c~f Uonticilr ancl Citiun~l~ip iu thc Statc of f~lori~la that 1 am filin~; this day in
accordai~cc, an~l in contorn~ity with Scction _'?2.17, l~larida Statut~s.
t was fornirrly a Ic~al residcnl of ~,~~1Z.- Q!_ and 1
(c~~~~ ~ ts~
resided at -_~_L-_ --~e~'oiv~_~1L.~- ~ Howc~~er, 1 have changed my domicile to
' (Strrtl and Numlx~)
and am and have bcen a bona fide resident of thc State of Florida si~jce _ ~ wt~_~- day of
now ~
S' P ~ , 19~
3 and I/~esid~ at - 3~
~ ~ (Strert and Number)
u) ~ ~ ~ . St._ Lucie County,Flarida,
(City~
and ihis statemrnt is to be taken as my declaration of citizenship, actual legal nsidence and domicile in the State
of Florida.
(Inserl here any pertineot tacis, such as salr of property or business, or relinquishment of employment at (ormer
domicile. removal of family to new domicile, purchasr ot home, rtc.)
Entering children in school: / ~
263821
FtlEO AND RECOROEO
ST_ I,UCIE COUNTY FLA. -
ROCER PBtTRAS
CLERK CIR~UIT COURT ~
RE~O~iD v=R~F~ED~..
S~ IT 12 4a PN'~3
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I FURTHER CERTIFY that i will rcgister at my local address when the registration books reopen, and
~ comply with all other requirements of a legal resident of this State. ,
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I FURTHER CERTIFY that 1 have no intention to rcturn to my fomier domicile, and I intend to remai» in
/ St. Lucie ~
~ . T • , _ , CountY,
~ Flatiiia,~Qern~anenUy.
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,y
~ . ~_~G._cc~G C~[~.-~ _ ~
~ ; (AJdress)
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~ Swo~n to arid subscribcd bcforc mc this _~7___ day of
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~ ~_f~K~c~------=-n.n. t~_73_.
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~ ?tOGCR POITRAS, CI.~RK CIRCUIT COURT
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j . --IIy~-- Dcpu~y Clerlc _ _
(To tx r~rculcd io dupl+..~~r ri~J uriyin.~l f~lrJ ~citli l'Ir~l. Ciicuit C~~url.:~nJ Ju{,h,.~a• ~+~th 7aa A~~.~ c~or)
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eoox z18 Pact 2~.~.0
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