HomeMy WebLinkAbout0595 Dc~l~ru~~~n a~ ~omicE~e ~~d ~~~i~~~~~h~~~ ~ ~
r~? ~rl~~: s•i~n•r~: nNn couN~~~- •rnx nssi,sso~i, 2~1293
S~.Lucie '
_ COUN1'Y, FLOltli)A:
Tliis is my drelaration of Domiciic and Citi•r.cnship in the Statc af Clorida that I ant filin~ this day in
arcordancc, and in conforniity with Scction 222.17, Florida Statutcs. • ,
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1 was farmcrly a icgal residcnt of , - and 1
tci~y) ~e) ;
resided at - u e- ~ . However, 1 have changed my domicile to ;
_ (Street #nd Nuntbcr) -,~p
ancl am and have been a bona ide resident of the State of Florida since day of
' now - • ;
~ , 19~y and 1 /~reside at ~ODd ~~(.~~c~ '
C~,G (Streei and Number) '
` Sr. Lucie '
_ ~/I• l~~i~-2~ =Qi , County, Florida,
ta~r) i ;
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and tliis statement is to be taken as my deciaration of citizenship, actual legal residence and domicile in the State ~
of E~lorida. , ~
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(Insert here any pertinent lacts, such as salr ot property or ~usirtess, w relinquishment ot employmenf at formet ~
domicile. temoval of family to new domicile, purchax of home. ete.) p
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Entering children in school;~ Homestead Exem tion: Y\~1
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t1'.,LqtCtE CON117l~ L
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- RECORURVEP r.t~C ~
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I FURTHER CERTIFY that I~vill register at my locai address when the registration'books reopen, and _
comply with all otl~er requirements of a legal resident of tl~is State.
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I FURTNER CERTIFY that I have no intention to return to my former domicile, and I intcnd to remain in
~ ~~~.e~~~ St. Lucie E '
, , County, ~
~ Florida, pcrmanently. ~ ~ ; T
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_ l'2~C~E=~C.~IZ~-r~~-
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- '~C, •.~,%i _ _ (Address) .
Sworn! ~~itd~sGgs$r~bcd bcfvr~~ mc this da of
V~~.: .r ~ - a~ , . _ y 3
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~?r=x~;~~- ~ c-__.^-, A.D. 19 73_~ ~
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~•~.`;8 , ;~~fi11S, CLERK CIRCUIT`C~URT '
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Tu 1~. ciccul~vl in du IN~Ir :~ud uri in.d 1J wilh l'Irr1. Circuit Cuurl. +nJ Ju hrrlr w~Ih "tac Aucctiu~
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