HomeMy WebLinkAbout0576 t3~ct~r~atian of ~3oms~ile ~ nd ~itizcnsh~p
TO 1lll: STATf: AN[) COUN"TY 7'A~ ASSI'SSOR, +?+~~ss
_ `St .Lucie , ~.vUN7'Y, f=1.0121!)A:
Tl~is is my drrlaration of Domicitc and Cititrnshi~~ in the Statc of riorida th~t 1 ant ~ling this day in
accordai~c~•, and in conformity with S~ction ?~~.17, I~lorida Statutes. .
1 was fornicrly a legal residrn~ of ~1.!~__ and 1
~ ~ . _ h ll'i!Y) (State) i
residcd at x_L-~ . Nowev~r, l havC Citaing~~ci my UWllll'IiC tu
lSl~eel and Number) ~
and am and have bt~en a bona fide resident of the State of Florida since day of
~ ;
~ 9~ now ~ 3 c~ C~ ~ ~ c~ ~
, , and 1 /rrsidc at ~-=-f'1i
'~7 (Street and Numbetj >
_S'~7~..f~ti~~(~.z . St. Lucie ~ _
County, Florida, '
(City)
and this statement is to be taken as my declaration of citizenship, actua) Iegal residence and domicile in the State
of Florida. ?
(loserl Aere aoy prrtinrnt facts, such as salr ot property or businrss, or relinquishment of employment at former ~
domicile, remoral of family to ne.v domicile, purchasa of hume, etc.)
Entering children in school:~ Homestead Exem tion: ~'1- `
P
! ?
f11E0 AMD RECOROE9
S1.ltIC1E COUN~Y fLA.
itOGE~ POiTRAS
CLERK C~RCUit CdURT. ~
RECORO YEfi~t~ED~....~~• ~
t~ 23 2 os PN'73
269086 •
. ,
I FURTHER CERTI~Y that 1~vil! register at my loc:al address when the registration books reopen, and
comply with all otiier requirements of a legal resident of this State.
I FURTHER CERTIFY that I have na intcntion to return to my forn~er domicile, and I intend to remain in
~ ~ St. Lucie
i~~~-c/ , County,
~ Florida, permanently. tc~~r) ~
~
,
.
.
~ ~ / ~~~1
.t -
. _ L'~ /uc _
(Address) •
~.•~•'~~~ti~~
SWot(v.l~,ajt~~~ribed before mc this 3 day of
` y;.
lic r~ ~ ~~z/ 7 3
_ `;_:.1_~, A.D. 19_.
; ,~,:'~7tOGER PC~I3'~S, CLERK CIRCUIT COURT
.
• ~i.•.;.-~~rtt.~4 . U k ~ ~
C ~ ni~c
, • : ~ s • i -De~it~, I e 4 807K P
~ (70 lm cxccutcJ m duph..~~: ~nJ uri~ m.~l I ~ w~ftb ~'Icr~ C~rcu~~ Cnu~l.:~nd du~.l~~:~tr Niti~ Taa Asscssnr)