HomeMy WebLinkAbout2327 '_.l~ . , f~:i: ' ? ~ ~ ._~~~i~~~
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St.Lucie
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'll~is is my clrrla~alion c~C Uc»i~iritr and ('itirrnsiti~~ iit thc St:tt: c~t~ Flc~ri~la th;~1 I am liliti~; ti:is clay in t
,,~~ur~lai~cr, and in c~onfurmit~ ~vith Sertiun ?2~'.l'1, I~lori~f:? ~t;ttutrs. ~
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1 was formcrly a Ic~al rc~i~i~ nt of ~ ~~~i /9_~~ S-------- N-d and I
(crtY) • - (s~s~r)
rrsidr.d at ~ L~~/`f l~
~L~ . I lowcvcr, I liavc changed my domicil~ to
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(St~rct and Nu~t~hrr)
ancl am and havc br~n' a Uona fidc rosidrnt of thr Statc uf I~lorida ~incc -__L_~vG
~ day of
-now ~
- - ~ , ~ 9-~-3-, anc! ~ /rr~ule ac _~~_~_~_e%~l!2~~_~`. s
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(Strert anJ Numbrr)
_ ~Q~--~T_~v~. ~ _ , St. _Lucie _ 33YV_Z('ounty, I~lorida, ;
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~~iicf tl~is statement is to be takrn a. my declaration ~f citi-r.enship, act~ial legal rrsidence .u~d domicilc i~i the St:~te ~ ;
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of l~lorida. t
(Insert here any pertinrnt facts, ~uch as sale of property or business, ur relinquishmeM of employment at former E
dumicile, remu~al of family t~, ncw dun~icile, pur~!?ace ot home, rtc.) `
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erin children in school:~ Ho~restead Exem tion: ~
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fIlEO AN~ REGOROEO
ST. ~UGz ~OUN?1f FtA.
RCGE` ?'rjTR~S
i CIERK i:. ~U1T COURT
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I .~MN u 56 ~H'~~ -
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~ THER CERTIFY that I~vill registcr at my local address when t}ie registration Uooks reopen, and .
1 FUR
~ comply with all other rec~uiremcnts of a legal residcnt of this State.
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~ I FURTI3ER CERTIFY that 1 have no intention to rcturn to my former domicile, and 1 intcnd to remain in
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~ Jd~ ~ ; c _ St . Lucie Count
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i y . (Name) KAMP-
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S~~~i~n. ~ ~ai, ~ s~fbsc~ibcd bc.orc me this _ day ot ~ ~ ~ ,
r i ng a re s s
~ . - , d. ~ ~__Z~. .f~o~ i ~S; ~ ~L,~ 3 3 y~ ~
;~ry;= dGER POITR , CLERK CIRCUIT COURT _
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- _BY - -
- D ut:y Clerk
' (To he exrcufrJ in duplica~r ~n~I nri~•in:d (d~•J ..~th ~~I~•~k ('irwi~ ['.•~~r~. anJ J~q•li::~re with Ta~ Asuswr)
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