HomeMy WebLinkAbout0690 Deci~ra~ia~n o~ Qa~ ~
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~ c~ -ri s•rnT~. nnu c'UUNTY -rnx nss~~sso~t, 26,7Q95
St.Lucie .
- ~._COUN"1'Y, I~LORIUA: ,
'I~his is my dcclar;~tivit of Dotnicilc at~d Citizcmbip in thc Stat~ af rlorida that I am filinb this ~I:iy in .
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.+ccordancc, and in confonnity ~vith Scction 222.17, rlorida Statutcs.
1 was formcrly a Icgal residcnt of ~t~ ~nd t
(Cicr) ( ce)
r~~sidcd at a.q ~ . However, I have cha~iged my domicile to
(St~ert and Number)
and am and have bccn a Uona fidc resident of ihc Statc of Florida since day of
now -p_L ~
, 19~., and 1 /~csidc at ~ • S -~°,~~c~n~e- .A4~ '
~ (Sttcet and Nu t)
~ . . St . Lucie County, Florida,
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and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of i~lorida. -
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(Insert I~ere any pertinent facts, such as sale ot pruperty or business, or relinquishment of employmcnt a! former ~
domicile, removal of fam~ly t~ new domicile, purchase oi home. rtcJ
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Entering children in school: ~ ~
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- : fIlED ANt~ ~i~CgR~EO
3~_ LS~yrE Ci~~wTr ~'i,A. ~ 'j
RGCEi? FOCfRAS I~ ~
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I FURTHER CERTIFY that I will register at my local address when the registration books reopcn, artd
co~nply with all other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intention to rcturn to my former domicile, and I intend to remain in
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~ ~d~ ' , S* . Lucie . ~
~ ~c~~r~ ' , County, ,
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~ Florida, pcrmanently. _ s~ e~ N but9 h~
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Sw~orn t~an~•su~iG
~~{~lic~1 6eforc me this day of
~ i~t : : ;
• ; , . ~ ,
, A.D. 19- 73 . 3
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RO~L'~t~ Q~~~~tAS CLERK CIRCUIT C4URT ~ .
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(Tu be eaeculcd in Juplicalc anJ uri~:inal f~IcJ ~~ilh ('IcrM Circuit Cuurf. and Juplnatr Kilh Tax Assecsor) ~ t`
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