HomeMy WebLinkAbout2750 ~ ~
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~~ir~~ of ~omi~i~e and Citiz~nship
r~ ~r~~i: s~r.~~ri: n~»couN~~~v ~I'AX ASSI•:SSOIt, 2642~5
St.Lucie
- CUUN'1'Y, f=1.OltiUA:
Tl~i. is my dcrlaratiun of 1)omicilr and Citir.cnshir in thc Statc of rtorida that 1 ant filin~ this day in
accorJ.~nrr, anci in confonnity with S~ction 222.17, Florida Statutes.
1 was forn~crly a lega! residcnt of :_1~/O _i2 R oPC> ~ ! S~ - - ~ - ~jq _ dnd l _ _ . -
(citr). (staee)
r~•s;ded at ___-~4'~S~__ N~_._ ~ However, 1 have changed my do icile to
- ' (Street anJ I3umArr) ~ rf e~
.~nd am and ha~•e bcen a bona fide resident of thc State of Florida since ~ day ot'
now
C/' Tc~i'i~1E7r2 ~ 19 Z~ and 1~reside at O 2 ~NE~ E81?OOK~
~ ' (Strcet and Number)
o a T H /`~aa T_~T- ~ U c~ St . Lucie County, Florida,
- - (City) ~
ur~d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of rlorida.
(Insrri hrre any perlinent facls, such as sale ot propertY or businrss~ or telinquishment of employment st former
domicile~ removal of family to new domicile, purchase of home, etc.)
Entering children in school: ~,.qu~F A~-A~1 ~'T Q~1 Y
~r~sfi~r~ -~a~t ~ Qx~Y-
s~.~~ s,~. ~..~r.~~ ~
sT ~ ~r.~n fu?.
~J~+~s
u~~ti ~ ~ ;.~r es~~
~K!'+?o~ 11£=if~f8
S~r 2~! 9 ~ 11H'73 -
26?4~'5
- 7
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I FURTHER CERTI~Y tl~at 1 will rc~istcr at my local address when the registration books reopen, and
c~rtp~*-R~tira~bt~krr-rectt+~e~ .
I FURTHCR C.EKTIFY that t have no intention to mturn to my former domicile, and I intend to remain in
~oa ~t rtT ,S7 1.,,~c~ c St. Lucie County, ' S
Florida, pern~arcntly. (c~tr~ ' ,
~ ~ .
. ~~~-~j4fl,'%; ~J , i (Name) -
, h .r G~-
~'~;-~r~ s'D 2 ~S~/Ea~-r3QooKE"
; .~t~';~ ' r~ ~ (Ad ress> _ -
,cJ oa T S T L w~, ~ j~~
~ ~...°'t. i ' ~ ~ = p,~¢ TN
~~Sin~ t~ t^~~attd;~{~ribcd htfvrc iz~~ iliis _ clay of / '
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n'• .•'v.•. ~
•..~~i.~+v~, 1~
~~~!S~_~a~' S -c~o n.u. ~9 _ ~~3 _
.RbC~~:~R1~P0ITRAS, CLERK CTRCUIT COURT
----?-r----------
~ - . _I3y_ t~t}~C1er_ v+. . .
({u I~t' CA~'CIIIi'i) m duj~h~ :~1. ~nd uii•~m.il I~I~ ~ t~itl~ ('Ic~l. Citcurt Cuutl. anJ Juplirale wilh Tax Assccu~r)
~K218 ~27~'7
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