HomeMy WebLinkAbout1576 Dec{aration of Domicite and Citiz~nship
~ c~ ~riii~. s-rn-~-~. n~ru cc}u?v-r~~ ~rnx ~ss~:sso~i, ~ 2~6033
sT. LucTr•. ~ _ ~~OUN7'Y, r•LOUin~:
~l~is is my drelaratio~i oi' Domicilr and Cititcnship in the Statr af Florida that 1 am filing this day in
:~~ror~lancc, and i~~ ~onlonnity with Srction 222.17, Hloride Statutcs. -
1 was fornirrly a Irgal resident of n-%F~ ~ i~~~ fl , ~!ss~J-_ and 1
(Cily) (State)
r~ ~idrd at ~~_11~i~~~_~,C~,D~__ . Howev~r, 1 h:~ve changed my domicile to
(S s~d Numbe~)
and am and have bcen a bon,i fide msident of the State of Clorida since ~~_~c.Cl- day ot'
~~.b1v p~1 , 19~, and 1 residc at ~~tr'~n ~E; r r G i.
(Strtet and Numbet) '
C~ ~~'C'CS.~- , S~ ' L.v c i~- County, Florida, t
(c~ty) ~
and this statement is to be taken as my dectaration of citizenship, act~~al legal residence and domicile in the State ;
of rlorida. `
r i r elin u' ment t em lo ment at formet ~
(Insert here any perlinrn! facts, such u sale of prope ty ot bus ness, o r q tsh o p Y
domicile, removal of family to new domicile, purchax of home, etc.) ~
~
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: _ i
If entering children in school, . ~
please list their names: - ~
~O~ ~~2~ ~~~4,r' ~rc~ vF, i2
_ i~
~ iafr~ ~ ~~:,~s
ST_ LUL~E C~UIitY fLA, '
G _ : ) ~T?Z1S
CtE ? K ° ;;,t C8tli1T
RFr4R;~ Y; = - "4
l~r ~1 2 ~2 PH '7~ -
r
2'76Q33
I FURTHER CERTIFY that 1 will m ister at m local address when the re istration books reo en, and ~
fi Y ~ P `
comply with all other rcquirements of a legal msident of this State. ~
i
1 FURTHER CERTIFY that 1 have no intention to return to my former domicile, and I intend to remain in t
i
.
i~L ~ ST. LUCIE , County, €
, i
F~ lorida, pcrmanendy. <c~~r) ~
- j
,_J „ :,..Ci,. ~ ~
- ; t
-r . _ ~ i.
: :
~ ~ c : ~ S IGi~tATURE ~
- ~,,~t a• r": ~ ~
, SworA.to
s~td~subsc~i,b~~.~,,~icfore me this day of -
- A.D. 19 74_. ~U S I r
• i~fai ing A"d ress
ROCCR POITRAS, CLERK C RCU1T COURT l~i'~ rc~ , rlorida
Ay 1'~1[ Hc eputy Clerk
~
(To be execute in duplicale and orifinrl (~Ied ~~~ith ('Irrk Circuit ('ourl, anJ duplicrle uith Tsx Azseswt) '
- E r? 2~4 F,,~E1575 ~ :
~
~ ~
- _ = ~ ~
~e"'~'~'-
~'=`s ~""~'~`:a'` ~..,-'.ju~' `'"s~~~"'~zf~~
~ _ . .
_ . ' ` . . ~ T ? lS~S::