HomeMy WebLinkAbout0160 /
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i~~ ~ri ~r s~rn~ri. ,1n~~~ c•vv~r~i Tr~\ ASSI~StiUIt. 26fi'72Z
St.LUCie
- CUUN']'Y, I~LOltIUA:
"I~his is nty ~l~•c{aratic~n of Uonti~ilc :inc1 Citi-r.~n~i~i~~ in th~ Stalr ul~ I~torida th:it 1 am filinp; thi~ ~iay in
;,.~c~r~iance, ancl in conlorntity ~vith Srrlion ~?2.17, t~loricta Statutt•s.
1~vas formcrly a Irral resi~l~nt of ,~hr ?7~Ie~S ~,,,e _ ,~_~_~~~1'`~~_` and !
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r~,i~lyd at ~~~/3 ~'~lk~~es nrcc i2~. - .}lo~vcvcr, 1 ha~~c cha»bed my domicilc to
(Strert and I3umbrr)
;,~:ct am a~id ha~~e been ~ bo~~a G~ic rosiclent of the Stale af F~lorid~ since 2'3 day oi~
_ ~ C~ , 19 7-~ and 1/r~ ulc at ----___"1 ~r/ ~v~ia•~ ,~/2
~ (Strcet artd Numhc~)
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a~id this statement is to be taken as my dectaration of citizensi~ip, actual I~~g.~i r~~ic3i:n~c ~?n~i c~oii~icile i~3 t11e Siatc
of Florida. '
(Insr~t hrre any prrlinrnt facts, sucA as salr of pruperl~• ar business. u~ rriinquishment of employmcnt at forme~
domicile, remo~•a! uf family to ne~v dom~cil~, pur.hasr ot hume, rlcJ
EnCering children in school:
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~f ILED Atif RECORaED ~
' ~T. LIiC~E :;.~UH1Y~'LiA. ~ - _
aocEa ~~~:~ks 4 ,
CLE ~t!c CI~.C'Jt* .CDllttT
RrCO~ ^ Vf `i F
- ~r ~3 ~2 ~.P~1'73
26fi i ~2 y
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1 rURTHEIt CI:RTIFY tl~at I~vill re~ister at my local address when the re~istration books reopen, and
` comnly with all other reqi~irements of a le~al resident of ti~is Statc.
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I CURTHCP. CERTIC'Y that I h.~ve no intention to rcturn to my former domicile, and I intend to remain in
T. S~ ~,~c c S* . Lucie
, Cotmty,
Fi~rida, pcrmancntly. (c~~r)
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~ , C:lr~' --Lvy,vLta-~ . '
• " = ~ (Address) ~ ~
y . > ~ G~.,t
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Swoi,Rto~artd subSc~c2! bcforc me this day of
' _ " ~ -~c~r n.n. ~~~73... -
_ . -
s RCfG~~R-` ~0~~'R~1S, CLERK CIRCUIT COURT ; .
~~~W' ' i
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, _ . __IIY_ - U _ aaoKzzo
; ~ ~eputy Cl rk
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(Tu be eaecutrJ in JupHca~e ~nJ uri~~u~.i tdrd ~~~Ih t'Irr1. ('ncuil ('i~uN. anJ Jupl~crtr ~~ill~ "fa? Aste~~ut)