HomeMy WebLinkAbout1571 ~ • ~ ~
. c,~~ ~o~~~ci~~ an~l Ci~~~
~~~o ~r~~~: s'fA"i'1: ANU ('OUN•rY ~rnx nss~~sso~i. 2`71932 .
S ~ . Luc ie
COUN"1'Y, LORiDA: -
Tliis is my ~Icclaration uf L~omicilc aml Citi~cnship ii~ ihc Statc of Florida thctt 1,un filin~; this clay in
accurclancc, ;incl in conformity with Section ~?2.17, Florida Statutcs.
! was formerly a Icb:il resident of ~a , ~1.i.~t.i~n ~
, (c~cy) (s~ai~)
residrd at f034 Po~ra~.ee LcJte Dic. - . However, I have changed my domicile to
(Street anJ Numbcr)
and am and have bccn a bona fide resident of the State of Florida since 26 _ day of
De.cer~be~z. , 1973 and [ /re de at ~~5j j~' ~~J
(Str¢et and Numbet)
Feir.f ~%On[~o' ~ St . Lucie COlillty, F~OI'I(~il,
(c~ir)
and tt~is statement is to be taken~as my declaration of citizenship, actual legal residence and domicile in the State
of Florida. _
(Insert here any pertinent facts, such as sale of property or business, or ~elinquishment of employment at former
domicile~ cemoval of family to new domicile, purchue of home, ete.)
Entering children in schooi:~ , Homestead Exemption: ~
~ L S~ ~7-
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t~,° ~
~iOGER ~OITRAt
ClEBK ~IRCUIT ~p(~~
RECORD VER~FiEO
.i~ 1 jQ ig pM'l~i
2'~1932
i 1 FURTHER CERTtFY that I will register at my local address when the registration books reopen, and
; comply with all other requirements ot' a legal resident of this State.
~ I FURTHER CERT(FY that I liavc no intention to return to my forn~er domicile, and I ii~tend to remain in
~ Foir,t l~.~ea.ce S t. Luc ie
! Florida, permanently. (c~~Y) ~ ' - - , County,
i
^ ~ + ~ C (Name)
~ ~ ;j ~y'•• ~~i~ -:f ~~.alw~.e - ap?f. )0~
" 115j
; - ; f - j~ I, ~G
~ ~ r ~ (Address) ~ -
i : ' ' t,~ ' . ` .'ys: p % ' '
Swom:to~t[~lis~;t~Ei~efore m~ this Jay ot ~/~j~ E d u/a r d ~l~ u N ho )
~ . ~ , : • ~r~ '
f ~ ~ A.1). 19_7~_.
~ ' . , -
- ROf~~,;; ~ •~AS, CLE CIRCUIT COURT
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+ty ~e r ~ BOOK ~2~ PASE ~5 7tJ
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s (7o be exrcutr~! in Ju~,1i:.~t. anJ uri; in.d filr h('lerk Cirruit C~url, a~~l Juplic: 1.• ~ci11~ Taz Asu~wr)
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