HomeMy WebLinkAbout2580 Dect~~^atic~~~ of nor~tE~:~e and Citi~~:nsi~~~
1~U 1'lll: S"I~ATI: ANl) COUN'l~Y "l~A\ ASS! SSOIZ, ~6~3t~6
S t .l.uc ie
- - - - . CUUN~'Y, f~ LURi l)A:
71tis is tny dci~aration of l)c~mirilc an~i Citizrii.l?i~~ in thc Statr of I~lorida that 1 am tilin~; this ~ay in
accor~:~ncr, and in conlormity ~vitli Srrtion ~~~'.17, rluri~la Statutrs.
1 was fornicrly a lc~al rrsid~•nt of -._~~~~i~~,~ _ and I
,h (citr) (sta~r)
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resided at SiR ~~.G~t ,~i~~f_-- However, 1 have changed my domicile to
(Strcel and Numbrt)
and am and have bcen a bona fide r~sielrnt ol' thc State of ~lorida since ~G day ot~
now
~F l~.c~ , 19 ~ 3 , and 1 ~i-~sid~ at _ ~i S f~.~.~--•.,+.` ~ .~c~ ~~r' -
(Street and Number)
,~~~1c~ ~ St. I.ucie _ County, Florida,
(c~~r)
and tl~is statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. ~
(Inseri here any pertinent facts, ~uch a~ salr of property or businrsa, or relinyuishment of employment at tormer
domicile, remo~al of family to new domicile, purcAase uf home, rte.)
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fT. LUt;f GO~~fr F~
~iOC:R P;~TR~S ~
; CLEFK C:~;.~sT ~~yRT
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I FURTIIER CERTIFY that 1 will re;;istcr at my local address when the registration books reopen, and
~ comply with all other requirements of a Ienal residcnt of this State.
~
~ I FURTHER CERTIFY that 1 have no intention to nturn to my former domicile, and 1 intend to remain in
~ G--~ ~ 1 S~ . Lucie
3'%fPc'~ , County,
~ ~ -
~ Florida, permancntly. ~
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~.d ~/L C~~ ~ ts~ t . _
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_ v (Name)
. `~.s~«...1~ .,r
~-i ~ T~~ f 1-/.,~ .
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~ j " ` ' (naa~ess~
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Swti~A to and Sul~~ibcd brf~re m~ thi, _ 1__ clay of
~j - ~ ' ~ ~ ~
, , ~ • 73
' 'r ~ , A.U. 19- -
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~~'~RAS, CLCRK CIRCUIT COURT
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- (To br esrcut~•d in du~~ln.~lr .~nJ ~~n,•~n.d td~ ~~hl~ t'Irrl. C'ircuit ('uurt.:~nd Jupl~ratr ~~ilh l:~t Awcsurl
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