HomeMy WebLinkAbout1168 ~ /
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~~c? -rtjt: ST:1'fl: A\U ('OUN~ Y ~r.~x nssf:ssoit, '~'~357'4
St .Lt~cie
- - - - - c~u~~rY, r• ~_c~iziun:
T;iis i~ iuy dccl:u~atiun af 1)c~ii~icil~ a~zd Citir.~i~ship in ihc Stat~ of Flori~fa that t am filin~; this day in
accur~lancr.. ~n~l in conlc~rmity with Section ~22.1?, i~lorida St,itutcs.
ff ~~i ~ 4~.~ ~~f i~ and 1
1 was formcrly a Ic~:~l rc~sidcnt of ' - - -
I ((:ity) (State)
~ = / ~ ~ ( . C~ ~
residrd at - _ . However, I have cha»ged my domicile to
(Slr~tit and Numlxr) '
and am and have bc~n a bona fide resident c~f the State of f~lorida since l-'~~ day of
now ~ _
- - , 19_~ and 1 /residc at ,i;' :r, ;_i ~ ~
~ (Street and Number)
. r St. LuCie County, Florida,
- ~ - - ~
~c~~r)
and this statement is to be taken as my declaration of citizenship., actual Iegal residence and domicile in the State
of Florida. ~
(Inurt here any pertinent facts, such as +ale of prop~rty or businrss, or relinyuishment of employment st fotmer
dumicile, removal ot family tv new dumirile, purchase ot home, etcJ
, .
Entering children in school;~ Homestead Exemption:J~=1
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i ST.L+~Ciz ;.JUMTY fLA.
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~ I FURTHER CERTIFY that 1 will ~rcgister at my local addmss when the rcaistration books reopen, and
~ comply with all other requirements of a Ic~~l resident of this State.
~
~ I FURTHER CCR1'It=Y that I have no intention to return to my fornier domicilc, and I intend to remain in
~
~ . ~ _ - St . Lucie , Count~ ,
c~ . , , - - - '
(c~~r)
Florida, pcrma:~cntly. / " ~ _
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S-rgnat~,4Ye (husUand )
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= S~~~arii (~v*i~~~~su~sCqbed bcforc mc this __c~ I__ clay of
. . , rsa~ ing a ress
~ .yV~~ G •~r
. "-t " ~ /~.I). ~ 9__~~t_
~
= ~n ROGLR , ~ CI.E CIRCUIT COURT
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1-.: ti' _ C ' . i 4~ ~ t
~5:~ ~i `4.~ y • _i, ^ .
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_ , . '~t ?3Y P~ rn ~ v?
t..~~ . C0•~. ~ ty Clerk
:
(TU bc c~~ cutcil in d!~.:~~, atc and i~i~,~in.~l ~ilr~1 ~.~tls 1'Ier1. llr. ~~il ('~~url. an~l duplir.~lr a,th "(a~ A.•..•~ti.rr)
" 8C0~( PAGE 1 ~6~
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