HomeMy WebLinkAbout2179 Dect~ra~ian of aor~~cite ~~d ~~ti~~~si~~~
•ro Tt~c sTnTt: nnn c'OUNTY 7~A\ ASSt:SSOR,
St . Luc ie 2638~2
_~T---_--- --~-•--CUUN't'Y, 1=LOR11)A:
Tl~is is nty dcclaration of I)omicilc and Citi•r.rnship in thr Statc of' f
lorida tliat I am tiling this day in
accotdance, a~~d in co~iPormity with Scction ''?2.17, Florida Stattitcs.
1 was formcrly a Icgal residrnt of L4~l~2~~'f~ Kl~t f~~ and 1
. (Cily). . (State)
resided at ~_C
~'~~T ~ M f1~~(~_.~~A~H~ However, 1 liave changed my domicile to
(Strret and Numbrr) ~
and am and have been a bona fidc residcnt of thc St.~tc of Florida since ~ ~a ~ day of
.
• now ,
_ 1 L 19~~ and 1/~esidc at L~°~
1~~'~C~~~ u'Q-
~ _ . ' (Streetand~~m~~)- -
. -
• _
lL?,~c~2 ~ - , St. Lucie _ County, FIorida,
(ci~r)
and this statement is to be takcn as my declaration of citizensl~ip, actual iegai residence and domicile in the State
of Florida.
(Inur1 here any ~+ertinenl facls, sucA as sale of property or business, or relinquishment of employment st tormer
domicile, removal ut family to nrH• domicile. putchase of home, rtc_)
•
.
- ~ ,
~-~°i~c~ c~re~
~a~~
af~x c,~•cu,T cou+er
Rf~ORD YE= c~~p
StiJ~ 9o~Ay~73
2638~z
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- - - -
- _ - - - -
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I FURTHER CER'I'IT'Y th:+t I~vill rcrister at my local address ~vhen the rcgistration books rcopen, and
comply with all olher requiremrnts of a legal resident of this State. ,
~ I FURTHER CERTIFY that 1 l~ave no intention to return to my forn~er domicile, and I intend to remain in
'
= LUiT -C^.~ . r"
~~--1 St. Lucie , County,
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~ I`•~~. • t~~ ~~~~Y ' \ 1 ~~-~_1 7iC~~• _
~ ~'g"'e;p I,,,~ 1 (Address)
~
~ Swon2 to and suUsrribcd brforc me thi. day of
x ,
~ - --------~~~r' A.U. 19 _ 73_ .
r "
~ ROGER POITRAS, CLERK CIRCUIT CO~RT
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