HomeMy WebLinkAbout1448 r/~-/{r~y~!J' jc ~n:t~ ~ ' /
~~~IiC.~~ Gi.~~~ ~ ilv~iV t-ii ~..Yr ~.~G..L~c 1•.i~ ~,.`.s ~
~ c~ ~~~ii~: s•rn•rl: nnn cc~u~.-r~' 1'AX ASSI~.SSO1:,
S t. Luc ie 26~s42
----cc~uh~'~~, t~~.c~itiun:
'I~his i~ my dcclar;?liun of Donlicil~ ancl Citirrnsl~i~~ in th~: St:it~ of i~lori~i.i that 1;ini filin~~ thi. ~I:+y iti
.,t<<~r~iancc, and in coiifonnit~• ~vith S~rtion ~??.17, F~t~ri~la Stati~trs. +
1
I was formcriy a Irgal r~sid~:i~t of -S~T~_~2L~1r~____._ ~'f~iL4 and I ~
- l1ci r) (s~a~r) (
r~•~icled at 33~~ . However, I have chan~ecl my domicile to
($trett and Number)
: ~u1 am and havc bcen a Uona fidc residcnt of thc Statc of l~lorida siiicc day ol'
'r/~ lIOW
_~~~,~[~t-/ , t 9 7 3 , and 1/~rc.id~ at .~C~~~ / t~~
~~G' ~ 7 G
/ (S1~eet and Number)
S~. Lucie COlI1]ty, ~'~OTl(~1,
~ -
(CiIY)
anct this statement is to be takcn as m~~ dec~aration af citize~~ship, actual legai residcnee and domicile in the Statc
~~i~ l~lorida. • '
(laseri here any pertinrnt facts, such as salr of properly or businrss, or rclinquishmont of emplaymrnt at former
domicite, trmoval of family to new domicile, purc6ase of home, ~te.)
Entering children in scnv~i: t
/
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'fllE~ Ak_~ P.E.CUFiEF$d ~1'
ST.LUC~r C~Ul~i'!'flL~• 6
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ClE~S G: :..~t? COt1RJf y ~t
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~ 26`7642 `
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1 FURTNER CERTIFY that i will reaister at my local address when ihe registration baoks reopcn, and
cor.ipiy with all other requir~ments of a 1ega1 resident oT tlfis Siate. ,
s
I FURTHER CERTIrY that 1 l~ave no intention to return to my former domicile, and I intend to remain in
~aL~- ~~~.-t.~ S*. Lucie f
, County,
I~lorida, pcrmancntly.
; - ~ ~
/~..~,~~,~r/ ~-y~~tz~-~'.~v ,~J;2'L~-~~-x- `
(Name) t .
~ •~,L;u: ~ / ~s~~' ~ 7G . ~
` ~r ~„sr ~ ~ = ~<..r uc, ~ y~t^/dJa«~s, ?
S C9 t" ~ ~ ' ' " ~ ~ V sq/ . .
S~vorn-~t~d,and ~subscr}b~3i:~lnrc me this ~ day of ~
- -__7T ~ • ; ~ °
. '~,••'`I `i. D~i ~ /1.11. ~7___/_~ t
_ ROG$~,~(~$A~$;~' CLERK CTRCUIT COURT . ;
? - ,~~~a~-,~K•,~~ - - - -
. .
: . . - _ _ .~y- ~ _ _ ~ ~ 220 FA~,f 14~5
- - eputy -CI.-eL BGO+t
; . , .
(Tu be exetulcJ in duplic~lr rnJ or~l:u~.d fd. 1~~th t'Ir~l, t'ir~uit ('ourl. auJ Juph:alr willi 7:~~ Ancc~ur)
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