HomeMy WebLinkAbout2312 C~~:c~~,.~~~~c~r~ ofi ~:jarr~'~~i~~ ~:~d ~3ti~~Lnsi~r~a
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! c) 7711: S7 A7'L AN1) ('UUh7'Y 'fA\ ASSI~.SSUIt,
SC.Lucie ~
-__-.__..----=-_--CUUN7'Y, I~LUltii)A:
Tl~i~ i~ my d~•claration of Uomicil~ and Citixrn,hip in thc Statc c~f I~lorida that 1 am ~iting this day in
:~~rur~iai~c~, aild in conCorn~itt~ with S~ c;tion ??'.17, Florida Stal«lcs.
t was formcrly a Ir~a! rrsidrnt of -----~~fQ~ ~ t'~_~'~~f~~~tf' and 1 ,
(cilr) (statr)
r~,idrd at ___~~~~/~'~^i~l~~`~ However, 1 have chan~ed my domicile to
- (Slrrrt anc! I~umixr)
.~~~d am and ha~•c bccn bona ficlr residrnt . of thc Statc of Florida si~~cc day of
now •
_ , 19._ 1_`~_, and t /ccsidc at __1 ~os (.~~CLS f~.~'
~ ~ (Street and Number)
~z.~t~_1.2~.~l~ , _St. Lucie _ County, Florida,
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ar~el this slatenient is to be taken as my declaration of citizei~ship, actual Iegal residence and domicile in the State
of f'lorida.
(Inseri here any prrtinrnt facts, such u salr of prupcrty or busineu, or telinquishment of cmployment at former
domicile, remo~~al uf family to ne~~• don~icilc, purchase of home, rte.) ~
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Entering children in school:~ Homestead Exemption: ~ ~
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2?'7249~ ~
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' ILEO AIl9 RECOROE~ ?
~ ~T. LUC{E COUNTY flA.
~ R4C~ F ~~~TRAS
~ C4ERk t i~GU1T COURt
~ P.FCORQ i'Cf,!R1`T}-~-~'~'~~ ~
~ Jut 1~1 il vi AN'Z~1 ~ . :
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I FURTHER CERTIFY that 1~vill rcgister at my local address ~vhen the registration books reopen, and
comply with all other requirements of a legal resident of this State.
I FURTfiER CERTIFY that 1 have no intention to return to my forn~er domicile, and 1 intend to remain in
~1Fils t~ ~/~~c'c r/,-- St . Lucie ;
, , County,
~=lorida, permanci~tly:. . tc~~y> ~
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, ' C~ • ~ -1-%-~`,-'j- ~ -'L'GE~~I~ ~/fiF~~c,~ ~`i~/r L'7"'C-_'~
i - s ~ . . . ' (Name)
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~ ' . - ` : ~ ame
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SwQrn~.to arjd sut~scr-ibed be:ore me this day of ~~l~ -l
~ ~ . i ing a ress
a'~`~ A. D. 19~~_. ~ It ; r~F,~ ~
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R6GER POITRA , CLERK CIRCUIT COURT T ~°~`~S'~
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~ _IlY _4~/t.c~ °ti~~~/~ ~
Deputy Clerk ~ ;
(Tu be exrculyd in duplic:rtc anJ nti!•in•l filed wi(h ('Irrk Citcuit Cuurl, anJ Juplicate wilh Tax Assrssor) -
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