HomeMy WebLinkAbout2243 ~GVa~~7IVi ~ . .
Q~c~ar~tioc~ o~ I~om~~t~e ~~d ~~t~z~ ns~:~ ~
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f0 TIIi~_ S"!'A"1'l: ,~~U ('OUN7~Y "CAX ASSI :SSOI2, •
St_. i~uCie COUt~"('1', t~ LUitll)A:
'lliis is my d~claratic~n af Domicilc .~ncl ('itizci~~hi~~ in thc Stat~ c?f f~lc~rida lhat l am filin~ thi~ d:~y in
arcordanrc, and in confonnity with Scction ~~?.17, Fiurici.i St~itutrs.
I was formcrly a Icgal residcnt of __~~LE V~ ~5~~ - and 1
(citr). (state)
residcd at ~~'~~~5-~ __.}lowcver, 1 havc changed my domicile to
- - ' (St~ert and ~umher)
and a~u ~~iid ~iavc bcen a bona fidc rcsidcnt of thr State uf elorida sincc ~ T~ day ot
4 [~t.~- Z ~ } 9~, aiid I /r~Sici~ at ~~V/L JII~E/d~~ ~L~~/7 ~~8'~ - -
- _ - - - - - (Streetand Nvmber)
_ - - - - -
~ ~T ST. ~~f
~1 ~ , St . Lucie County, Ctorida,
(c~~Y)
and this statement i~ tu be taken as my declaration of citizenshir, actual tegal residence and domicile in the State
of Florida.
(insert here any pertinent facts, such as sale at property or business, w relinquishment ot employment at tormer
domicile, temoval of family to ne~v domicile, purchasr of hume, etc.) ,
Entering children in school: ~
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f~
LUCt~ CO~N~Y
ROCER P~ITRAS ~
CIERK C!#;,y~~T C4URT
RFCARi1 VER1F~E0~,.,~,~
-
, -----~~I IZi3 PH'73
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~ 263921 :
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T.
I TURTHER CERTIFY that I~vill register at my local address when the registration books reopen, and '
comply with alt other rcquirements of a legal residcnt of tl~is Statc. ,
~ ~t
1 FURTHER CERTIFY that I}iave no iniention to return to my fornier domicile, and I intend to remain ;n
~ ~~~2T ~T. ~flL= - - St. Lucie _ Co:,,~ty, .
a Florida, permancntly.
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~ Stste of Indiana ) _
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TippeCarioe COUIIty T ~ ~ (wame)
_,~3~s ~c~1or,~l~~~C
- Gv ,~.~F YEIrE
ti (AdJress) ~'yD y~yo6
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~ S~tig~~;:,jo and sub.~ribcd Ucforc me thi<, _ ~3 clay of
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~ A.I). 12--73_-
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3:3 ' ~
l~? camiasion ezpires Auguat 13, 197?•
~ ,lfotsr~ - lic De I~:z~y C i e rk
f~~//~f,,~f~'• j1;,`,1~~~~`` ~ (To bc rsrcu~~•d in Ju{~Gc~tr and uii~m.d (d: d~.~(h ~'1: ri l'ir.t~it ('uort. and duplicslr ~+ilh l.+x Accc:sut)
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