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St.Lucie
_---C~OUN11', I~l.nltll)~~:
"Il~is is my tirclaration ol~ 1)~m~icil, ;~ncl ('itircnshi~~ in thr St;itc of I~lorida th:~t I atn filin~; this cl,~y in
accordancr, anJ iii co~ilormity ~~~ith Secti~~n 2,,.17, I=lurii!a St:rtutr..
.
I was fonnrrly a Ic~al rcsi~lcnt of _ . ~ ~ E _ _ - , / C _ _ and !
(('it~•) (Slate) ~
residcd at ---~Q
X_--~_. Ilowcvrr, 1 havc chai~bed m~~ domicilc to
(Sttect and Kumhrr) ~,L`
ancl am and have bc4n a bon.~ fidr residcnt of thc Statc ot f~lorida sincc day ot~
now ~
- , I 9- and 1 /i-ctii~tc at ----`~~~'-LY '
z- -
(Slrcet and Number)
~~~e h c~ _ _ St . Lucie _ Co~~nty, Florida,
(ciiy )
and this statement is to Ue taken as my.deelaration of citi-r.enship, ar.tual Iegal nsidence anJ dotnicile in the State
of Florida. ~
(Insert here anp perlinenl tactc, such as sate oT pr~~perty ~~r buciness, or relinquishment of employmcnl at former
domicile, temoval of (amily to ne~v dumicile, purchue of fio~ne, ete.) ~
~ ~
A 12. C (~CN~ i J~low !1 ,l,ve CA~ N- f', n~
S~-~,,,~ ~-ti;h~ -+o b~Y. :
. #
Entering children in school:~ liomestead Exemption: ~ 3
- ~
134~~' `
~ F~~.Ep tcECGR0E0
St.IUCt: ~1GUNTY FIA.
P.GG~ : v1tR~5
Cl~={ ; :~~~t COURT
II RFr". " , i~D..~ ~
,
Ja~ [8 2 oi PM'~
_ ~ ~
,
~
1 1=URTHl=R Ct:RTIrY that t~vill rrri~trr at my loc.~l address whcn thc r~gistration books rcopcn, and
comply with all othcr rcquirrmcnts of a Ir_~:,I resiclrnt vf this Statc.
~ ruii~rEi~:R CLRZ~IFY that 1 ha~~c iza intrntion to rcturn to my tormcr ciomicilc, and I intcnd lo rcmain in
~i~ehc St. Lucie
Co~~iltY,
I~lorida, pcrmancntly. <<~''''~ ~
e
. . , - -
~ , . C ~ ; S ign ure (liusUai~c~ )
' ~ ' ~~LjI'/, .i d~/J`- _ 1 i ~~/y~ ~
`~'v--~
_ . - - ~ -
: ~ Signature wi.fe )
_ . ~ - t~' - . f ~ ~ ~ ~ _a ~
: S~uorti to :~nc) st~~i~;;~l~c~l hcfc~r~• mr thi. _ ~ay of ~ , -
. ; • ; ~ ~.ai~ii~g a ress
- ~ :
- - Q''~~=-- -----.n.n. ~v _74.--~ ~=T. Ti~~Ce .
, _
~ CC~t.. FOI'T1 S, CLtiRK CTRCUIT COURT
- - - -
~ ~ .
}3y
)ep~it.y Clei•1~:
(Tn I~r c~i•cutc~l in Ju~~l~~,dr .~n•1 .~u~•i~~.~l 1dri1 ~.~~U~ l Ir~l 1'ircuil ('n~irl. aml Ju~~h~ .~1~- n~lh la~ Ac~cat~~~)
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