HomeMy WebLinkAbout1484 ~~`~r~:~:~n t~~ ~~nic~~~r ar~ C~i~~er~:~i~~p
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S t . Luc ie
_ CUU\TY, PLOItIDA: ~
'Il~is is ~i~y dcrlaration of l)umicilc and Citiirnship ii~ thc Slatc of Flarida that 1 am filin~; this J;t~ in
ar~c?r~iance, an~l in roi~furmity ~viih Sectic~n ?2~.17, l~lorida Statutes.
t was fc~nnrrly a Ir,:il resid~•nt of -_-.~~~L~,Y ~ _;l?lti I
(CitY) (State) •
1
n~,iclr~ at ~ .~~~p~ ~ . Howevcr, I havc cha~~bcd my d~mici~c to
_i~~da)• at~
an~i' am ancl havc b.~n a tbona~ fid ~rresidrnt of the State of I~lorida si~~ce
~ now
- , 19__7'~, and 1 /~esidr at 3ps.L ~'Z`• ~~p ~ ~
(Street.and Num7~er)~~~"^'~~-- - -
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~ . St . Luc~.e County, Flor~ct.t, ~
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an~i this statement is to be tak~n .is my declaration of citizenship, actual legal residence and domicilc in the State ~
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oC I~lorida. ~ ~
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Qnsert here any pertinent facts, such as sale of property or business, or relinquishment of einptoyment at former ~
domicile, remuval ~rf family to ~ew domicile, purchasr uf home, ete J !
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Entering children in sct~ool:~ Nomestead Exemption: ~ ~
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' - 2'~3900 .
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i ~ KfcoROEO •
f11E0 AN ~~U~TY fl~-
5 St.IUC<<_ ~ ~ITRAS
~ Ro`'~ - ~t; COURT
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~ I FURTHER CERTIrY that 1 wii! register at my local address when thc registration books rror~•?~. .::~~~f
~ conz~~ly with ~;11 other rcquiremcnis of a legal resident of this State. ~
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:@ 1 FURT[~CR CERTIE~Y that I have no intention to return to my former domicile, and.l intend tc~ rcn~.~~~} ~~~s
~ ~t ~~h~ ~ St. Lucie
('c~~.;~:t~~.
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Flaricla,~•t~tn~?ncntly. lc'`'•~ • o
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_ ` ----5 ignature ( husband ) - - - - -
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'=3 ~ . ~ . Signat.ure (~~~ife~
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" Su~oti~,'"'"aud ~~scribr~l hc(orc mc this clay of ' - .
~.ai in ac c..e~ 5 -
' - - - n.n. t _74_. N,o,.- , - -.~3 S~~Q
ROGER POI AS, CLERK CIRCUIT COURT o~~'~j ~rY,~a,uh
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'4'~ - By _
_i~~i v-c. ~c.~
Ueputy C] erl~;
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- (Tu t.c r~:culrJ in Jrry~h~:dr an~l ur~~ ~n.~l fdril ~~i:l~ ('Icr1 1'ir~uil Cuur~.:~ud duplir:~l•' ~•.~fh 1:+~ ~~'••••~~r)
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