HomeMy WebLinkAbout0383 Qecl~r~~iar~ o~ ~or~~~~~~ ~r~d ~~~i~c~s~:4~
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1 U'TI11: S'1'ATL: AND COUN7'Y 1'AY ASSI :SSOIt, _
S~.Lucie
GOUN'1'Y, I~LOItIDA:
Tliis is my drelaration of Domicilc and Citizcnship in thc State of Ftorida that I am tiling this day in
.~rcordancc, and in conformity with Scctian 222.17, Florida Statutcs. •
I was formcrly a kgal residcnt of c~~ - A ~`t'U~J"' ~F'~^~/~ and I
(cicy) (s+ate)
residcd at e~'~ ~o~ . Howcver, 1 have changcd my domicilc to
_ (Street aod Number) i
anci am and have becn a bona fide resici~nt of the State of Florida since day of ~
~
now '
, 19_~ and I/reside at o %S ~
(Street and Numbcr)
~~-,~~,`c- , St. Lucie County, Florida, '
(c;~r) -
a»d this statement is ta be taken as m~~ declsration of citizcnship, actual legal residence and domicile in the State ~
of Fiorida. . s
(Insert bere anr pertinent facts~ such u sale of property o~ business, w reliaquishment o[ employmeet at former
domicile. remavsl of family to new Jomicile, purchase oi home~ ete.) ~ t
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Entering children in school:~ Homestead Exemption; ~
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ROGER PDiTRAS
. CLERK Ct~~UiT COUIIT
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I FURTHER CERTIFY that I~vill registcr at my lacal address when the registration books reopen, and
comply with all otlier requirements of a lega! resident of this State.
, i
I FURTHER CERTIFY that I liave no intention to return to my former domiciie, and I intend to remain in
~ ~ ~
;E ~ St . Lucie
T ~ ~c , , County, ~
~ Fiorida, permanently. (c~~r) ~ ~ ~
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; •'~~J ;~I . CO''•. M~me)
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~ (Address) • ~ `
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Sa~vd~rn.tv'and i~bse~i~d~bcl'or mc this ~ day of ~'L ~ ~
f.,.`. ;~v_ 7
- • A.D. 19~_ 3 .
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ROG~R...~OTTRAS, CLERK CIRCUIT COURT ~ ~
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(To be earculyd in du~:hrrl.• :~nd uii~•in.d id~•d ~vilh ('Irrl. Circuil ('uurt. anJ duplitale w~16'Iax A~tic~sar)
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