HomeMy WebLinkAbout2606 D~c'~~~a~~~ r~ c~~ Dc~~~ici;~: and Cifi~~nsi~~p
1~U 7~t11: STA"1~1~. ~~I~n ('UUti7~l' '1 A\ A1tit.~SOK. 2641g2 ,
St.Lucie `
_ - CUU\7'Y, I~ LORII)A: ;
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Tl~is is tny ~Icclar:~tic~n ot~ Du~niciir anci C'itiz~n,hip in th~ Statc of Floric}a that 1 a~n fling this day in #
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accordancr, :~ncl in c~ttfonnity with Sc~tic~n ~~?.17, Florida Statutrs. }
1 was formerly a Ic~al msid~nt of i.~~1!~.~~.----- and I ~
. ~ ~CtIY.I, tSZ3LC~ z
r~sidcd at ~____`Z~~~ . . Howcver, I have changed my domiciic to
- ~ (Street and Piumbr~)
and am and ha~c bcc» a bona iidr residcnt of thc Statc of C'larida since ~ ~a day of
- ~ 14----___., aizd 1 /r~ icle ai ~ S ~,Lr~T~ ~~.~,,r ~~~d~~. +
(Street and Number) - . -
~ T~ __i . St . Lucie County, Florida, ~
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and this statement is to be taken as my dccl~ration of citizensl~ip, actual lcgal residence and domicile in the State ~
~f Florida. ~
(Insrrt dere any pertinenl facls, such as sale of pn.~+crly ot business, or relinyuishment of employment at fotmet
domic~ie~ ren~oraf of family to ne~v domicilr, purrhax of ho~nt, rtcJ
Entering chiZdren in school:
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~ ;~iiici~ co~~r~~.
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~r 11 14 0~ ~!'~3
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264182 :
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I FURTHER CERTIFY that 1 will r~gistcr at my tocal addre~.s when the registration books reopen, and ;
comply with aU othcr requireme~zts of a Ic~al resident of this State. _
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I FURTHER CERTiFY that 1 liavc iic~ intention to rcti~rn to my former domicile, and I intend to remain in :
. ~,et,~ St . Lucie County, '
Florida, pern~anently. ` C a.~d r ~t~)
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1 ---(Name)
4 ,ti,. : _ ~ ~S- ~~'P~tt`~,r~'_ •
~i~•-..,rf• (Addrecs)
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Sti~it3~;=to ant~,~q~bec~ brfarr m~ [hi~ _ ci;i~• ot
~ •;~'I . ~.l D ' ? ~
'I~- A.t). 19__ 73_.
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~ ~~'-4Rf3~ER• ,i'f~~S, CI.r:RK CIRCUIT COURT •
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(To I.c c~riutid iu ..'~,,•:si.ilc su•f .vo, ,~;.rl fil< <i ~•.dh ( Ir~~ ('ir. uit f nurl. anJ dupli: ~ta ~aith Tax As~c~sot)
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