HomeMy WebLinkAbout2267 'j''; > 2~246~
~•:i v~G . iitil'. . . ~~.J~ ~ •!j`i : :~.i i'..'~ , ~
• • ~.a
tt) "T((I~. S"I'~~Tl: A~t) C(.?t~\"t~l''1'~~\ :1SSi.~~t~lt,
St.Lucie
COUI~'!l'.I~1_Oi:i1~:1:
Tl:i~ i~ nt~~ ck•rlaration ul~ Uumi~il._ ;incl ('itizci~`I~i~, in tli~• titatr c~i~ I~lorida that I:mi filin~; thi: day in
accorJ:~iuc, and in ronformity ~vith S~~tian ''~~.17, I~Ic~l~i~ia Statut.~s.
1 ~vas ~ornicrly a 1cga1 rr~idrnt c~t~ - . _ --`i,--- - - :
, 1 _ _ and I
tc'~ ~ Y ) (st atr )
resided at . Hok~ev~r, 1 h:i~~e changcd my domicile to
- (Street and N~nnhrr)
and am ai~d 1~avc bce.n a Uona licic re~iclrnt of thc SC.~tc of Florid:~ sincc day ot'
now
, 19_.~~, anct 1 ~r.idc at _ ~~~5__ . 0~-Q4d~_-~~ ~ .
- ~ - - - ^ - - (Strett and Number) -
St . Lucie _ County, Florida, ~
-
(C~i~ ) '
~
and this stalement is to be takrn as my declaration of citize~~ship> acti~al l~~bal residence and domicile in tl~e State
of Florida.
.
(Insert here any perlinrn! facts, suth as Ulr uf prupe~ty or busiaesc, ur trlinyuishmcnt of empluyment at forfne~
domicilc, remo~~a) ot family to nc~v domicilc, purchasr o( hoine, rtc.) •
~
.
~
Entering children in school; Homes~ead Exemption: 1---1 ~
~
2
1
27246'~ - :
• F~~EO a~~ k=_coROEo
sr. ~uc~F cou~tr f~,~.
RdGER Pi,ITRA$ ' •
CLERK CI~CU~f COURT
RF~OR'., yr~+;:F~~r..~.~.
>
J~ t~l 9 4zAN'1~! `
~ .
i
i
I FURTHL'R CERTlFY that I will register at my local address when the registration books reopen, and
comply with all other reqt~irements of a legal resident of this State. ~
. ~
I FU~tTIiER CERTIE=Y that ! liavc no intention to return to my fonner domicile, and I intend to remain in ~
~j~ St . Lucie , County,
Florida, permanently. ,j. ~~'`Y~
` ll ~ ~ • ~ ~ r' D i
' . ~ ~ i ' 1
. - ; (Name) J F} /h ~.4 0 /1~ ~
. I - - . i i~1 ~ , ~ ' . f
• ~ r` - . i
;n "-4 ; _ . - ~ ame
, : . .
- ~ ` -
SwocP;t ~ d•suli~r~b~d beforc me this _~~L__ day ot ~
G.~ i in g a re s
- ~ „ ~e't`'".``~t - A. D. i 9 _7_4 D~Z ,L?~a b~L.c_._.
~ROGER POIT S, CLERK CIRCUIT COURT
. . - Q~~
. -BY ~?eputy ~Ier
c~~
(To be esrculyd in duplic:+tr :n~J nri~•~n.~l f~l~•d w ith l7~•rk Circuit Cuurt, and Jupticatc wit1~ Taa Assccs~~r)
_ ~
~s
_ -
~
. , - '
_ . . _ _ _