HomeMy WebLinkAbout1475 D~cta~a~ian a~ ~ar;;;~~:: ~~z~ ~s~~~~~,~:~~~~?~~~
zs~sss
l c) 'l~l ll: S'tATt: A?~'U ('ClUN7'Y 'I'AX ASSI :SSO1Z,
St.Lucie
- - - COUN"1'Y, I~ LUltll)A:
71~ix is my dcclaratiun of Uotnicilc and Citiz. nshi~~ i~i th~ St;it~ c?f f~lorid:i that I,~m tilin~; thi, ~i;~y i~i
;l~cur~lancc, and in cont'arntity ~vith Scctian ''22.17, 1~lori~ia Statutrs.
. . •
I was formcrly a Ic~;al residcnt of , Q~ , and I
(Cilr) (Stalc)
r~ sided at However, 1 hsve chan ;ed my domicile to
- ($trert and Number)
•~nd arn and have bcen a bo~~a fidc resideni of ihe State of rlorida since day
now
, 19~y and ! /~csidc at ~ -3a~ ''~6l~~ ~~~i-~'~ '
, (St~ert and t~tumber) ~
. St. Lucie County, rtorida, _ _
(~~r)
a~id this statement is to be taken as my declaratioii of citi•r.enship, actuai tegal residence and domicil~ i~z the State
~f Florida. -
(Inxrt here any pertinent facts, such as salr of property ur business, or relinquishment of employment at tormer
domicile, remov~l of tamily to new domicila, purcl~ase ot home, rtc,)
Entering children in school:
G~~~
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~y~ ~~9c'
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FILED Akn P.'_CORDL~ ~ •
- ST. WCIt COUN'ii' F '
~LEF,4CE; ?)1tRAS ~ :
• ~ RECfiR, ~ i,~-:i:U~t COURt ~
~ Vf~t.-tE0`~ -
~ ~y ~5 1D ~2 Ay ,73 -
- - 26'~6f ~
- ~
~
. ~
I FURTHER CERTIFY that I~vill rcgistcr at my local address when the registration books reopen, and , f
comply with all other requirements of a le~al resident of this State. ~
I FURTHER CERTIFY that i}iave no intention to rcte~r~~ to my former domicile, and I intend to remain in
f
' • S'' . LuCie County, !
Florida, perma~cntly. (c''r~ ~ ~3/~s •~we> cc c~~s ~ { .
- (Name)
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v.., • - ' , ~
~ ~.u....,~~
,,•~G~;{ ~~T ~ C (AdJress) :
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; ~ .....ti. pG _ r ~
.
SwoYn~d~.ft~~t~'~so't~b~~efore me this day of
= e~r_ ; . - G : ~ k ' ' '
_ ' ,'-w - , c : ~P` Q ~ A.D. 19_?
3 , ~
' ; ~ , ~
~=~b ~~F~~~ ~ ~ CLERK CIRCUIT COURT
- - .
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•f:~~~,'~. , a "rz~o t ,
G~ ~ ~ ~.4'l2
- y ~ ~ sec ;
. --nY ~j ~
- . . _ ep~i~y ~,ler ~
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(To be etecutrd in Juplir:rte a+~J uriE~~n.il f~ d~v~Ih ('li•rA t'i~~uil C~~ur1.:~uJ Jupl~..~tr ~tilb T:~a A~sxc~~r)
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