HomeMy WebLinkAbout1309 .
D~clar~~fon of ~orr~i~~~e ~~d Citiz~nsh~~ +
~ro ~c~ii~ s~rn7~~: nt~n c'UUN7~Y 7'A\ ASSI~SSOIt. 2~963~
St . Luc ie C'OUNTY, i~ LOltl I)A:
Tl~is is my declaration of Uomirilr a~i~l Citi~rnshi~~ in ti~c Statc oi~ rtorida that i am (iting this day in
accordancc. and.in cc~nformity with S~ctian 2?2.17, Florid,i Statuies. .
' t
1 ~vas formc~rly a legal resident of __,~1~~C.~ o~_+'~_____ , e~ o r' ~ and 1
(CiIY) (Sl r)
msided at '~=z---~
a
c `r° . However, I have changed my domicile to
- (Slrret and Numbrr)
and am and have Ixcn a bona fid~ retiidriit of ihr State of Florida since , J~ day of
now Q.~T ~o o ? `2~ o,-T
!Yo ~ - , 19.~~_, a~id I /~resid~ at r~ ~ Z
..-..r. (Strett and Numbet)
_ J~n ~ e r,. ~ Q~~ _ , St . Lucie County, Florida,
(c~~r)
and this staternent is to be taken as my declaration of citi-r.enship, actual legal residence and domicile in tlie State
of Florida.
(Inseri here any {+rrtinrnl facts, such as sale of properly or business, or relinquishment of employment at former
domicile, removal of family to new domicile, purehase of home, etcJ
Entering children in school: Homestead Exemption: L_-_~
~a~%~ l,C/.
s.
~
f ~ 0 AND RECQ_RQ~Q
S~. L IE CQWI~~i FLl1.
R CER POITRAS
Cl£!tK-t;tRCUIr COtIRT
RECOItO YER~FtfO
8~c 3 9 vz ~'~3
26963~ -
- .
I FURTHER CERTII=~' that 1~vill registcr at my local address when the registration books reopen, and
comply with all other requirements of a legal rrsident of this State.
~
1 FURTHER CCRTIrY that I iiave no intcntion to rcturn to my former domicile, and I intend to remain in
St. Lucie
, County,
Florida, permanenlly. ~c"''> - ~ ~
~
G~/
ame)
_~-u / ~ ~.o
. . (Addreu) -
~ " : " . ~c'p.~-.s-~ ~ a
S~~•ar~ t~y;ai~~:sa~srribcd bc~fc?rc mc this _ day ~f ~j '
~ ~ G`' t A.D. 19 ~3 ~ ~ ~
. ,
"•'RO~R="~'O~~It11'~, CI.ERK CIRCUJT COURT
i - ' ~ ~ - - - -
~ , i,tj-- 3 . (t~~ ~
~ - . `~J'i iJ-;'~' *'BY ~h'1 G 80~K ~+~1 PJlGE1JV~
:
; ~ ••'4`~+~~ ~e~~,_~::y l c~ -
6 0 • ~ : ,
"•~?t~..~~~+`~ ~Fu 1'c cxrcutr.l in ~luplic:~t•• .~nd nn~~u~ ~I Id~ w~th ~ h~r{. ('ircuit ('~~nrl. and du~~l~~: ale wiU~ la~ A~sessut)
_ _ _ _ .