HomeMy WebLinkAbout2896 Qec~~~
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I:) '!'l ll: STA'1'!: r1N1) ('UUN"l~Y "1'AX ASSI .SSUit,
S~ , Luc ie 2~5$~
_ ____.-~.~.~__~_COUN'1'Y, I~LUItIUA:
'lliis is n~~~ drel:ir.~tioi~ uf Dc~micitr and Cilirrn.hi~~ in thc St;~tc af l~torid.~ th;+t 1 am filing this ilay in ~
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a~~~~r~lai~ce, and in conforntity ~~~ith Scctivn'?2.17, Floriclci St:~tutrs.
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1~vas fonnrrly a Ic~al residcrtt of , t~~
'_S~L~_S~A.~_ and I
(c~~r) (s~a~~)
r~~~icfcd at _ v~~-~L:~~~t1y . Ho~vcvcr, 1 havc changcd my domici[e to
- (St~er! and Numbar)
.snd am and have bren a Uona Cde residcnt of the St~te of 1=lorida since ~ n day of
_-(J~~'_3'~-~!~.~ , 19_~, anct I /rc ulc at ~ ~ , ? ~
(Street and Number)
° St. Lucie _ County, I~lorida,
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.~nd this statement is to be tak~n as my declaratioi~ of eitizenship, actual lrgal resid4ncc and domicile in dle State
c~f t~loriJa. . '
(lnsert here any pertinrnl facts, such as calr of prarerty or t~usiness, ur rclinquishment of employment at former
domicile, rrmoval of famil~• to ne~v domicile, purchase of home, rtc.) ~
Entering children in school; ~
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i~lEO ~NC RECOROE0 ~
S?. LUC~E ct~vNTY f~A,
ROGffi ?C1T~t~S ~
ClEP,K t:f Cl11? COORT
RFf`CR~~ ~EA~rfEti
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Oc~ ~1 3 24 PN '73 ~
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I FURTHER CERTIFY thst I wiil register at my local address when tl~e registration books reopen, and
s comply with all othcr requirements of a legal resident of this State.
? I FURTHER CL'R Y that I liave no intention to retiirn to my fornier domicile, and I intend to remain in
~
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. ~L S* . Lucie County, j
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` Florida, permanently. • '
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,CL ~ % C~ ~
- ° (Name) ~
. l,v I~~~.,~~~ °
, , . cwaa«~:) `
= Sworn to ~nd subs~cd~'i9fo,re me this day of :
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- , n.n. i~_73 ,
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RClG,~$,:~~O:IT`F~; ~~RK CIRCUIT COURT .
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_ ~ --~_~'ry~ ~ 80Dx~~9 rACf2~~~
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~ '~Y~... eputy C1.er :
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(To be eaeculed in Juphca~e anJ urytm.il (d~ ~~~Ih l'Ir~l. ('~rcuit C~~urt. anJ Jup6.rlr with "I:~a Acsetsor) ~
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