HomeMy WebLinkAbout1495 ~
~ ,
[?ect~~
~~i~n of Qor~
:~~~le ~nd ~i~~~:~,~r~s~~~~:;~
-i~~i~; sTn-rt: nn~u couN•rv •~~,~x nss~:sso~i, ;~,6'76'76
St .Lucie
-_COUN7'Y, I~LOItl1)A:
"I7~is is my drelaratiun of U~micilc and Citizrnshi~~ in thc St;itc c~f Florida that 1 am tiling ihis ~lay in
~ c~r~lancc, an~l in conformity with S~ction ''?2.17, I~lorida Statutcs.
~
1 was farnicrly a icgal resiacnt of ~ , and I
(c~~r) (s~a~e~
r~~;ictrd at i. Howcvcr, I havc changcd my danicilc to
- (Straet and Number)
anci am and have bee» a bana fide resident of the Statc of riorida since l0 day of
, 19;C.2, and 1 /~resui~ at `i
(Street and Number) ~ s'
t
. ~Z- ~ p.,,~.. p . St. Lucie County, l~lorida,
~c~~r)
anct this statement is to be taken as my declaration of citizenship, actual legai residence and domicile in the State
of l~lorida. , ;
f
(Insert here any pertinent facts, such as s~le of property or Dusiness, or relenquishment of employment at former i
domicile~ ~emo~•al of family to new domicDr, purch:.se of home, etc.) !
;
Entering children in school:
. • s
~
- . _ ~
~ ~t
J ~ FILEO aN{: ~:£CdADEO - .
at LUCt: t; ~tlMTY FLA. I~
. - RD~ER F_ ~7P.A5 `
CLERK ~OURT ~
° rrR^ vf'-. .:f0
~tMl J I ~ D4 ~ '73
;
y
~
- 26'76`76 ; ;
s
. !
.
~
. ~
. ;
. s
,
. . ~
I FURTHER CERTIFY that I will register at my locat address when the registration books reopen, and
comply with all other requirements of a legal resident of this State.
i~
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in . i
,
~G ~ ~ S* . Lucie `5
-~~---~-t ~ , , County, t
Florida, permanently. (c~~r) .
.
' ~ ~ ~
- ~tsy . ~~c
` ~ „ . . ' (Nsme) ~
~v~ .
• •.j1jv' ' ...'i. ; . t
~ _ i ' ~ ~t f~ ~l!~.C?rt.~c>~, ~rl~ ~ ~ F
~ a: i ~ ' .r~'.~:~ (Addfess) r'
t-. ~a, r n D n
: N : . . . g . +a~' O : ~ - _ r--- r ~ .sG~ i~""~`-'~ ~ / i ~
Sworn toland.su~~`ribec~`bcfo~;.~ne tliis S day of '
"r~ !4= i~
; G„'• , n.n. ~ 9_ 73 ~ =
-----~-7;,--T'i+ e `t~'~"•,.w . - . 's
y~
ROG~R ~'0?I~'~~5~, CLERK CTRCUIT COURT ~ .
_ - F,
_ ; ~
_ - ~ ~~~,22d -i492 .
. ~Y ~,yi c _ Lr c ' ;
. _ Ueputy Cl. Tc - . :
~ • , . ~
(To 6e exeeutcJ in Juplicate anJ uri~~~n.e! (ded ~~iUe ('lerk ('iti uit Cou!!. anJ Jupficalr Milh Tax Asuswr) z±
t~
• ~i
i