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-r~ 1~i~c srn~r~: RNI) ('UUN~I~1• ~r~~~ ,~ssi~~~c~ii. ~ 2'~3352
St Lucie
~ ----C~Ol)N7~Y. I~LOItil~~1: •
1
'Iliis is my dcclaralio~~ c~l 1)omicil; an~l ('itizcnshi~~ in lhr St;it~• of I~Ic~rida lhat 1 ani filii~~; this ~lay in ;
i
accordancr, ai~d in coi~fonnity wilh Si•cti~?n 2~?.17,-I~loriua Statutrti, i
1 was fonncrly a Icgal rcsiiirnt of . m l~._ S I< ~ 6- o IJ-- ~~/-1~ !r fI /1/ anJ I a
(Cit.') (Slate) ~
residcd dc ._~3pa__ J~mcs---/~?~ . Howcvcr, i have chai~~cd my domicilc to ~
~ (St~ecl and N~nnbrr) ~
and am and have bren a ba~~a Cdc residcnt af tlic St:~te uf Florida since ~U day ol ~
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/ now ,p }
19_Z3 ancl I/4'~sicl~ at _~~/N.DI~'!/LL V/LL~'~E ~_(/~-T~. LoJ p 7 ~
~ ~ (Strcet and Numlxr) ~
~ EN 5 L ~ ~El~-LN--- _ _St. Lucie_ _ County, Florida, ~
(cily)
and-tliis statement is to be takrn as m~~ drelaratioii ot citi~enship, actual Iegal r~sidence and domicile in the State "s
of Florida. ~ ~
s
(Inurt here any perlinenl facls, such as wle of pruperty or bucines.a, or relinquishmeot ot employment at formet ~
domicile. cemoral o( (amily to ne~v domicile, purchase of home, etc.)
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Entering children in school:~ Nomestead Exemptioni ~
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2'73362
, FtLEO aK;, ~E~;~RQEp -
ST. LUV7~ 44~~NTY F~~.
RGi,~= -QiTRA$
C[EF.x .,;UI~ COURT
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I t=URTHER Cf:RTIrY th:?t I~vill rc;~iclcr at my local adclress w~hcn thc rcgistration books rcopcn, and
com~~ly with all othcr re~~uircmcnts ot a lc_~~I msidrnt of this Statc. ~
1 rURTlII:R C'L;RTIFY that 1 h,n~c nc~ i~itcnlion to rcfurn to my tormer domicilc, and 1 intcnd to rc~nain in
i
~ E~s - - -St. Lucie ~ ('o~,nty, ~
florida, pc f~a~;lq~ntly. cc'~~r~
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c;,'~:'~~ ; -'vG = Signature (husUan )
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_ ~ ; ~Sig ature (coife)
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Swo tQ ~~ttF ~b~'~1Gctl hcfc~rr it~~ Ilii•.~~-_--- ~lay ot ~ ~
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ROGI:1. PO I tAS , CLI: RK C T RCU I'T COU RT ~ ~ 3 f~S7
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:
y I)Pp«t.y Clerk
(T~~ bc c~cculc~l b~ Ju~,I~i:Jr .~n,l nt~~•in.~l filril ~~ilh ( I~ol. ('itcaif ('ontl.:iu~l ih~pl~c:~l~• t~ilh I:~~ Ac.cct~n)
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