HomeMy WebLinkAbout1306 ~G~~c i u~tEQCi a~ _ ~i0~
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"i t) "I~IiG S'fATI: A?~i) CUUI~"l l' 'I~A\ ASSI:SSO!t, 2b~55~
c t- 1„r i s~
, CUUN7'Y, l~ L01211)A:
"Tliis is my drelarati~n of [)omii;ilc and Citiz~nshiE~ in thc Statc of I~Iorida lhal 1 am filinh this ~1ay in :
accor~lancr, and in cunfonnit>~ with Scction "'?2.17, Flori~la StaUitcs.
,
1 was formcrl~~ a Icgal resid~nt of , and I
(ci~~) (sta
r~ ~idcd at ~ !~G~-Q- . Ho~vcvcr, I ha~~c changcd my do~~~icilc to
- (Strect and humAer)
:u~d nd ve bc.:n a bona (idc residcnt of thc Statc of Florida sincc x~ day of
now J~ ;
, 19 ~3 a~:d I~residc at /-~t•~ ~
(Street and Number)
St. LuCie County, Florida,
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cc~~r) 3 3 ~{S''~ . ;
and this statement is to be taken as my declaratio~i of citizenship, actual legal residence and domicile in the State ~
i
of ~lorida. . ' ~
(Insert hete any pertinent facts, such as sale of ~~ro~erly ot 1+usiness, or relinquishment of employment at former
domicile, remo~•al of famiiy to ne.~ domicile, purchase of home, ete.)
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Entering children in school; ~
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. . 26'7554 !
I fILEO ~MO ~£COii0E0
' ~ - ST.LUCIL ~JUN7Y FLA. ~
~ R1:~;F"~ tRAS ~/ivi'~
CLEa!~ C~ ••:v:7 COURT ~
I Rrcr,r'_ .-~'~tE~.._~„~~
~ - Noy I 3 oa PM'73 i
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and
comply with all othcr requiremcnts of a legal resident of this State.
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~ I FURTuER CERTIFY that I have no intention to return to my former domicile, and I intend to rcmain in ;
~ • - S* . Lucie t
~ , County, ±
~ Florida, pemlanently. (c~~r) ~ 1
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~(Addrcss)
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'fl'`Y S~vorn to a d subs~ribe' '~i~fqre me tl~is ~ day nf .
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~ ~au~~:'• . A.D. 19~73 . . '
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~ ~ ` ~ ~'(~.ERK CIRCUIT COURT :
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;:„k, r•I('f~u be c:cculcJ in Juplira~r rnJ uti~~~~~.~1 fdrJ a~vU~ l'Ir~{. ('ircuil ('uutl. anJ 1I11~~ItCJ~C KIIII ~I:tl Asscstiu~)
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