HomeMy WebLinkAbout1473 D~c~~~
~t~~n of ~orni~i#e ~~d C~t~z~~sn~~
~ t~-r?i~ s~t~n-ri: n~ri~ ~~~u~~~~f ~~nx nssi:ssok. 2'~5953
ST•--LUCIE ('pUNTl', I~LO[tlUA:
~
Ti~iL is n~y d~cl ~r:,tion of Domicilc and Citirenship in th~ Statc of Florida that 1 am filinb lhis day in ~
a
a~~orclancc, and in cunformity witli Scction 222.17, Florida Statutrs. ~
~ ~
1 was formcrly a Icgal resident of _ ~ aitd 1
(Cily) (Stata) f
r~ ~i~icd at . However, I have changed my domicile to
(Street and Number) ~
a,~cl am and havc been a bo»a fide rrsidcnt of' the State of rlorida since ~7 day of
, 19~3 and 1 residc at _y/3 a
n ` ~ . Je^~~'~ Cy`fi~ (Street and Numbe~)
. ,
~ ~ z~ ~ County, Florida,
(cit y 1 . . .
:~nd lhis statement is to be taken as my deciaration of citizenship, actual legal residence and domicile ~n the State ~
of Florida. ~ ' • ; ~e~~~~ '
insert e e lfoy inent c, a~:r le o
pry~~u ness, or ~eli'nqunhment of employment at formet ~
domicile. temova of family to oevv do icile, purchase of home, ete.) ~
~ .
ENTERING CHILDREtd IN SCHOOL: ~ HOMESTEAD EXEMPTION:
If entering children in school,
please list their names:
-
.
~
~ Ft~.ED ~k~' YECCrA0~9 ~ ~
S'i. IUC;C v )'Ji1?;~ ~
i RC~: • ~,;t~:.31~ ~
i CLEFK r .:~.UIT 001lRT
Rcfn~,~ Y" _8~~•~••µ'~`~ ~
~ J ~
~ $ li ~'T~
~ 2'75953 ~ ~
~
i. J
!
~
' ~
~
3
~
1 FURTNER CI:RTIFY that I wil! rcgister at my local address when the registration books mopen, and ~
comply with al! otl~er req~airements of a legal resident of this State. ~
I FUR HER CERT[FY that 1 ha~~e no intrntion to return to my former domicile, and I intend to remain in
~ ~ ST. LUCIE
' 7r- , , Couniy,
Florida, pcrmancntly. «''y~
~
~ ~
, • ,
. ~
_ • ; ~ ~ ' ` 7`~" ~!G _
c.a
. " ; ~ ~ S IGI~1A
' " . : ~,s.
Swvrit ~to ~nd•sublcii~i2d bc~ore mc this ~ day of -
~ ' , .
S';
- ~ ~~Q ~E~~/ A. U. t 9 74 ~f~ri~i j:~
ROGCR POITRAS CLERK CIRCUTT COURT ~ 1 1 ress
' - - ~~_~j, o~~ , Florida "
,
B _ R,.c~u~( ~~D~c,lu'.~ Deputy C~erk !
~
(Tu br eYrcWed in dupli.~tc anJ ~~n~:in:~l fdrd ~~ith Clrrk ('ircuit Cuurt, anJ duplicate a•ith Tax As~essot)
' :~_i 224 PAGE1472 ~ ~i
~ :
~ ' ' ` F `
'~y= -r~k~'' },-E~'r,#'*~.'.-.~ .~~i ~ - j I '
~x~
~ ~s--~ J~~~~
.cr ~ ~ r i~.:~ ~s- s-: r - Z w , .
" ~r . ~"e ~ . _ . .
» ~ °?E'',„ 4 5a- 'a"~.~..,_~..; . . "..~*_-i ~