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Decl~ration ~t i~~rnic~~~ a~d C~iiz~CtSh~~ '
~
"f0 T!1!: S"I'ATl: AND ('OUN7'Y 'I'A~ ASSESSOK, 264092 ;
St~. Luc ie ~
courrrY, i~ Lc»t»~: ;
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Tliis is my dcclar~~tion of Damicilc an~i Citizrnshi,~ in thc~ Statc of C'lorida that t am filing this day in
accordance, and iii confc~rmity ~+~itli Scrtion "'22.17, I~loriita Statutrs.
1 was formcrly a Icgal reside~ti oi LfL_L° R
A
c~_ v~/~ TO Ri G o and 1
_ (c~~r). ~s~.~~~
nsided at _ 1- ~O M 1 N ~.~1" . However, 1 havc changed my domicile to
• ' (Street a hun?ber) .
and am and have be;en a bona fidc resident of tl~e State of Florida since 2 9 day of
- _ _ now . -
_ - -
- A ~ G ILS_..T , 19 b?, and I/residr at l S~ al
ft F~' S~"
' (Stteet and Number)
~ f'~ ~Q ~r P~ C R~~~ St . Lucie County, Flo»da,
' tciiy~ _ ' .
,
and this statement is to be taken as my declar~tion of citizenship, actual legal residence and domicile in the State
of Florida. -
(Insert hete a~y perlinent facts, su~h u wie ut property or buciness, or relinqui.chment of employment al former
domicae, removal ot tamily to nea~ domicile, purchase of home, etcJ ,
Entering chi ldren in schoo 1; H A v E ~4 T T E N~ E D D A N~?~ C ~ R ry
hl i b h S G NOo L~ A N O ~ N D I A N IQ ~ V E R ~ o~~ v N/ T y ~ E 6 E ~
ST
LUCIE COUMTY FLA. ~
ROCER POITRAS
CLERK CIRCUIT COURT
_ RE~4RL~Y~ii1FIF
S~ 10 I ~ 46 AH'73
2s4QS~
1 FURTHER CERTIFY that 1 will register at my Iocal address wl~en the registration books reopen, and
comply with all othct requiremcnts af a le~al resident of this Statc.
I FURTI-IER CERTIFY that I havc no intcntion to rcturn to my [orn~er domicile, and I intcnd to remain in
Fa ~ T P/ E kL F_^_ St . Lucie County, '
Ftorida, p°rmanently. (c"Y) ~ RpFae~ ~JRGwe (1eg~
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: SSvo@~~~~~~~ 3u~~c~l~ogd~~cfor. me tiii; day oi'
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~ , CLERK CIRC' " COliRT
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.~"'•,~.~T~a~``~~`~~' 6L'OK~10 FAi,E~~~
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(Tu hc a•~acul~vl ii~ Jur~lii:~lr . ~i fil~ ,1 ~~~1h ('1. +L ('iri ~~ii t'~~u~I..u~i! l~U~~I1~.Ylt HIIII IJ\ A+sc~wf)
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