HomeMy WebLinkAbout0094 . . :
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St .Luc i e ~nUN"1'Y, l~ LOltll)A: ~
"l~lii. is tny ~l~claratiun ot I)omicilc ;u~cl Citiirn,hi~~ ii~ th~. Statr ui rlorida th;il I am filin~ tltis ~lay in :
;t;,c,r~lancc, ancl in ront~c~rmity witi~ Srrtion ~''2.17, I~lori~ta St.itutrs.
• ~ ! ~ ^~•~u~`~ _ and 1
1 was formrrly a Ir~;il rrsidcnt uf ~~/L~- ~~'s' -
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~lowcvcr, I havc chan~cd my domicilc to
~~~,~~t~ ~ ~,c 1~~-~`~= - .
_ (Strert anJ I~umbr~) ~~C.~~ ~d,~ ^
.,nd am and havc hecn a bona fidr r~siclent of l~lorida since ~ ~day o1'
' now ~
~ . ~ , 19 7`3 ~ and 1 /~rc.id~ at ~ .~02 / L
~(Street and Number) .
`y~~ . St. Lucie _ County, Florida,
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anct this statement is to be tak~n as nty drelaration of citizenship, actual legal residence and domicile in the State
of I~lori~la.
(Insett herc any pertinrnl facts, such ac s~le of pruperty o• Dusinrss, ot relinquishment of employment at former
domieile. remo~al of fam~ty Io nrw domic~k, purch~sr of home, etc.)
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I FURTIiER CERTIFY that 1 wil! re~ister at my locaf address when the registration books reopcn, and
cor~ply with all other requirements of a Icgal resident of this State.
~ I i'URTI-IER CERTIF'Y that 1 i~avc no intention to return to my former domicile, and I intend to remain in
~ti~ S'' . Lucie County
~ - ~c~~r) ' / . • ~
~ Florida, permancntly. ~ ~ ~~~~''~L
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~ (Name)
. . . - , ~ ~ ~ °2 ~ ~ .
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• (Address) -
~ ~ . ~ . D~s L A~.R; ~RS~ ~
~ S~ti~~n~'to•epd.subscri~ad~beforc mc this day of ~
~ , ~~Y - - 1
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`~e~-„~,y _I~JG~R FOI'~'~~~-CLERK CIRCUIT COURT •
~ . 0 R
. - , 1-r. ~"1 c ` c~ c~ 800K FaGE a~~ r
. . - BY lleputy Cl. r~ , '
=x
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(Tu be ezeculrJ in dupli.ate and ~~ry~u~.~ drJ ~~;'h l'trr{. ('ni nit C'~~url. anJ dupli.atc ~cilh Ta~? Atsxtitior) ~
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