HomeMy WebLinkAbout0840 Decl~ratios~ of Dor~~icile and Citiz~nshsp
7'O Tlll: STATI: ANU ('OUNTY 'I'AX ASSI:SSOR, 265009
St . Luc ie_~ ~UUN'i'Y, F LURI1)A:
'll~is is my dcclaration af' Uc~micilc am1 C'itix~nsi~ip in thc Statc of ~lorida that 1 am tilin~; this day in
accordancc, and in conformity with S~rtion 22?.17, Flurida St.~tutcs,
I was fo~rmerly a 1rFal residcnt af _~__~,,_~~~'~!~~~%t-~~ , ~ and 1
, ~ (ci~r (sate)
resided at _ _ Howevcr, 1 have changed _my mic' to
Street aad Numbrr) ~ ~
and am and have tx~en a bona fide resident of the St• e of Florida since day ot'
n~ s~~ now
_ (~f - , 19_aCs2y and I /~residc at _
(Stteet•and Numbcr) _
~ St . Lucie County, Florida, r
;
(c~~r) s
,
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State 3
of Florida.
(Insert here any pertinent facls, su.h as salr of property or busioess, or relinquishment of employment at fo~mer
domicile, removal ot family to new domicile, purchase of home, ete.)
Entering children in school:
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` FILED tiHL? P,= 9
COR~ED ~ '
~ ~ ST. IUC~E COUNTY FLA. :
~ ~ R~GE= P~~T3AS '
~'~{~,Q~i/ CLE~K C:::CbiT COORT '
- P,FC~RC YEf'~r1E0...~,~~ '
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Oct 3 II 31 AN'73 = `
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' 26$009
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I FURTHER CERTIFY that 1 will rcgisier at my local address when the registration books reopen, and ~
comply with aU other requirements of
a Iegal r~sident of' this State. i;
~ I FURTHER CERTIFY th• 1 have no intention to return to my former domicile, and I intend to remain in
~ , , . St. Lucie , County, ~
(citr)
~ F~e~~a~ apei~ly• ~
~ , ~ ~ ~ • ~ . , s%Gl~~ ` ,
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. i ' ~ (Name)
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~ i~ 'K ~O.l•~til-
'~Ct G ' ~Address) i~~'°'~1
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Sworn to and suUscriEcd bcforc mc thi; day of
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-~sz~~---- A.t~. ! 9_ 73
C-"C
~ ROGER POITRAS, CLERK CIRCUIT CO T ~
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; B~~K F
~ DePuty C r a
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(Tu bc cacculcd in du,nli~atr auJ un~:~n..l I~IcJ a~11~ l'Irrl. ('ircuit t'ourl. rnJ Juplicate w~tb laa As.~cscw)
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