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St.Lucie
- - - - COUN'Tl', I~ LORIUA:
Tliis i~ my drelaration of Uomirii~ and C'itirrnshi~~ in thc St:itc of Florida tl~at I am filing this ~lay in
;~~•rc~rJanc~~, :ind in co~ll~ormity ~vith S~ction "'2~.17, 1=1ori~ia Statutrs.
1 was formerly a Irgal resid~ nt oC 1~~~'~ . - and 1
(City) (sqte)
r~ sided at ~ . However, I have changed my domicile to
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(Street at~~1 Number)
and am and ha~~e Uecn .i bona fidc residcnt of the State of Florida since day ot'
YIOW ~ ~
~tl~~-.-~.`-- ~ . ~ ~ :l ll l~ ~ /lC~I(~ t 1l ~ _'c!
(Street and N r)
St . Lucie County, Florida,
(c~tr)
and this statement is to be takrn as my declaration of citizenship, actual legal residence and domicile in the State
of l~lorida. ~
(Inurt herr any prrlincnt facts, sucl~ as vlr of properly or businrss, or relinquishment of employment at fotmer
domieile, temoval of fa~nily to ne~~ damicile, purchase of home, rteJ
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Entering children in school:~ Homestead Exemption: ~1-~
; FILED ~4! ~E,r,URpEO
ST. IUCtE ,".Jt1NTY F~A.
ROC.n : li?RAS i
i , CLEP.t ~.':~~i~ C4URT
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1 FURTHf:R CI:RTI~Y that I will re~_istcr ~it my Ic~cal address when the registration books reopcn, and
~ com ~I ~vitlt all olhcr rcc uirrmrnts of a lc,sal rrsiclcnt of thi~ State.
~ 1 Y 1
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~ I I=URTHCR C(:RTIFY that I havr nc~ intcntion to r~turn to my forn~cr domicile, and 1 intcnd to rcmain in
,
~ S~. Lucie , Coimty,
-
~ I~lorida, ~cFCZ~j,ently.. ' ~
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: Signature (husband)
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S i i~a ture ~,*if ~
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~~~~cirh~t'~:~~d'.~~'~~'' ~ird bcfurc• tnr ihi, d.i)' of
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