HomeMy WebLinkAbout1317 Decl~r~~ion Qf Qomice~e ~nd Ca~ii~~ship
7~0 THI: S'I~ATt: AI~U C'UUN"I'Y TA~ ASSt~:SSUK,
st . Luc ie 269638
_ _ CC)UNTY, 1~ I.URII)A:
Tliis is my drelaration of Uomicilr and Citizrnshir in thc Stat~ of rlorida th;?t 1 am filin~ this day in
accordance, a~id in conformity witli Sertion ''~2.17, Florida Statutes.
1 was tormcrly a Icgal resident of ~
, - and 1
lL ) _ (state)
nsided at 3O',y._! . However, 1 have changed my domicile to
(Street and Numbcr)
and am and have bcen a bona fidc resident of the State ot Florida since _~dd_ day of
now ;~A
~ , 19~~, and I/residr at ~
~ 3 1~.~C
~ ' e • • (Street and Number)
St LuCie County, Florida,
(Citr)
and this staiement is to br taken as my declaration af citizenship, actuat iegai r~sidence and domicile in the State
of Florida.
([nsert here any pertineot facts, such as sale of property or business, or relinquishment of employment at formet
domicile~ removal of iamily tu new domicile, purchasc of home, ete.)
Entering children in school:~ Homestead Exemption: ~
. FILEO A!!p RECOROEp
~S ~-~~iS1i%i+'~ ~ e Si c~c ~v c ST. LUCiE COuNTY fl~. ~ 1~ .
~ ROCER POITRAS
CLERK CiRCUtT COUR1
_ RECORD YERlFIFD ~
~ ~ ~0 24 ~'~3
. 269638 ~
. ,
; I FURTHER CERTIFY that 1 wi11 register at my local address wheR the registration books reopen, and
' comply with ail other requirements of a legal resident of this State.
k -
i
; I FURTHER CERTIFY that I have no intention to return to my fornier domicile, and I intend to remain in
. 4 :~t . Lucf e
(city) COUnty,
~ Florida, permanently. -
~/9/ic e_ /~7. ~r t d ~ ~
~ ~ ~G~~ ~ ~/`1.el.t-
(Name)
,,~~,...ur....;,., - - -
; p ~ t , (Address) -
. c
' r.~ , . O
Swor~. ~'~~j •siibsc:~i~;bcforc me this day of
j~. w n. D. ( 9_ 73
; ~ - . r~. ~ = -
,Rd~R:I RA.S•,= CLERK CIRCUIT COURT
i ' ~ ~ r
~n• , ~
~ . $ ~~3epuLy- Cle b00K~:~i PAGf
(To M1r earcutrJ in Juplica~. :mJ ~~ri~~m: t~lc~l w~th t'I..A l'ircuit Cuurl, and Juph.alc wilh laa A«c«or)