HomeMy WebLinkAbout0095 • ` f . _ { /
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~ c~ ~r~ii; s-rn~r~: ,~n?u c~uh''I'Y 7~,~x nssi:s~c~~z, 26~s~3
St.Lucie
CUUN"1'Y, I~LO1:11~,1:
Tltis is~ n~y clrclaratiuu of Doini~ilc :in~i C'itiie:i.hi~~ in thc Stat.~ uF t~loricta thal t:~~i~ tilin~: Ihiti ~l:iy in
.t~~orclancc, aiid in c;o»formit~• witl~ Sr tioi .,~~?.17, t~lc~ri~la Sl.~tu •s. 3
K i
t was farmerly a Irgal resid~ nt of LZ. and 1-
i y> ' ~ (state) ~
rrsidcd at % ~ . tlo~vcvcr, I h:n•c chan~;rd m~ don~icilc to
(St ert id f~umbrr) ~
a~id ant a~tid ha~~c brcn bona fide resident ot' tl~c Stat~ of l~lorida si:ice - - 73 day o'
now ~ .
~
_ , 19~_, •and t /rc.ide at ___~~G 1 ~ ~
~ ' _s~ ti \ - ~
' ` ~ ~ (Sttcel and Numbcrj,
` ~ y~-~ ~ ^ SC. Lucie
(c;~y) ' Cdt~nty, T'torida,
and this statement is to be taken as my declaration of citi-r.~nship, actuai iegal residence and domicile in the State
ot~ Flori~a.
(Insert hrte any pcrlinrnt fact~, such 0S C:~IC O~ rfU(7C~~}' O! busincss, or ~clii~yoishment of ~mplo~•ment at formet
domicile, trmov~l of family to new domicil~, purcha~e of humt, rtc.}
Entering children in school:
~~~t~ ~y.tc-~L1 ~ .
- ~„ZS~U,~. ~
~ `
~~~~5~ FIIED Ay^ RECJROEO vi~
~ ST. LUCIE COUHTY flA. ~
~ ~ ~ ROG=~ i•.~,!TRAS
~ c~' ~ CLFtKC:-'v'l~li C'JURT t t
~P.~Cn~'~ VER FIEO......,.~. i
Ocr 23 I i 34 AM'73
_ 26~6`73 ;
. ~ ;
• ;
~
I FURTHER CERTiFY that I will rc~ister at my local address when the registration books rcopen, and
comply with all other requirements of ~ leaa! resident of this State.
t FURTHCR CERTIi'Y that I l~ave no intention to returt~ io my former domicile, and I intend to remain in
~ S* . Lucie
rlorida, permanently. ~~~~y~ , Couniy,
- - _ - _
.
. ' ~ _ „ ,
~ . ~ ~.1, . •t; " x.`1~~.
Jly; ! ~''!.O/.~' (Na' e
_ r• ;
•3 ~
_ ~ ~ jY"` - ~'~1 ~ -
r
~ ; _ J _ _ ' (AJdress)
- : . . :.r: /9Q dh iy ~'a.rs en/
S~~orn to ~~td-;subscrij~c~tieforc mc this ~ 3 day of /
.••'v 1` , - -
- ,~~a:~~ n.n. ~~-73__.
ROG~'R"'P~~TRAS ~ CLERK CTRCUIT COURT - ;
. _
_ _ . . . . ~~~K 220 9~
--BY - - ~--~'~S`_ c~ tt f
- eputy C .er
(Tu be execulcJ in Jupli.atr anJ ur~~~ui.~l ldril ~~i ~'IrrA ('~r~ uit ('uurl.:~i~J Juphc~lr ri~h 'I:~x Atsc~~~~r) ~