HomeMy WebLinkAbout1677 Dec~~rati~n af ~or~~ici~~ and Citi~~~r~~~
~ip
i u~i <<i: s~i~n'~'i-: ntiu c~vut~~~ 'i nx-~ssi ssc»t,
ST. 1.UCIE-- - C'Ot)~;'I'1', I~LOItIi~A: ~~6110
'1'l~i~ is my ~krlar,~iic~n ol~ 1)c~micil~ :u~~l ('itiirnshi~~ in thr St:~t~~ of rlori~la that I am fiting this day in
::~~~ur~lancc, and in conformity with Scctiun ,,,.17, I~lorida Siatutcs.
~
1 ~vas formrrly a Ir;~al rrsidrnt of - ~~~.'2 .t~ _ , ~ ~ rSC and l
(('ity) (Statr) ~
r~;idrd ~t -~~~-4__~~ ~-_~-l~~ . Howcvcr, 1 havr changcd my domiciic to
(5lrcrt an~! Num
<~nd am and havr be~n a bona r~a~ resident of ihe State ~S t=lorida since _ day ot'
, 19_`c and 1 residr at ~ t~? I
~ (St~ert and Number)
/c~ ~ Q~~
~ . ~ ~ ( ) C'_( e County, Flotida,
(c~~r)
:~nd this statement is to be taken as my declaration of citizenship, act~~al legal residence and domicile in the State
of I~lorida. !
~
(lnseri here any pcrtinrnt facts, such as s:dr of pro{.erly or husinrss, or relinyuishment ot employmcnt at former
domicile, remo~al of family to ne~v dumicile, purchase o( I~ome, rtcJ
Ef;TERING CNILDREN IN SCNOOL: HOMESTEAD EXEMPTION: ~ ~
If entering children in school, ~ ;
pZease list their names: ~
:
~
~
FlLEQ ' a,: ~'JADED ~
ST. tUCi% ':;;UNTY FLA.
GO.:~-. ~ " 'flA$ '
c~r ccuRr ~
4Fr--r , ,
~t ~3 I6 ~~'7~
' l S Y1 l ~ ~ ~ ~ ~ ~n c~
~ ~
2'~611Q ~
?
1 FURTtlL'R CERTIrY th.it I will rr~~istcr at my local address ~vhen the registration books reopen, and !
~ c~mply with all othcr rcc~!iircments ot~;~ legal r~side~it ol'this Siate. ~
~
~ I FURTHER CERTIFY that 1 ha~•e no intention ta return to my former domicile, and 1 intend to remain in
~ ;
- r ~~L----- - - ST . LUCIE , County, t
~lor~da;-'~@rnia.ncntiy.
. l; `~f~ . /J . ~
" .1~~~~``' r . •~'~~~~I~~ T.
ry ~
~ i ' ~:l I^\
. ~M.~. j ~ ~ j
. ~ ' - ~ ~ ~ i
- - ~
` ~ ' ~ CS J~ GiJA ~
~ e~ !A F~
Swotrr to an~ Ci~bscribcd licforc mc this day ot ~ ~ '
f ~ 74 ~~D~ ~ ~ ~ ,
- - A. n. ~ - -
ii~g c ress
RO~~R POITRAS, CLERK C RCUI1' COURT ~ 2 t-Ce , Florida
By y 1)eputy Cl erk
(To hc c~ccutcJ in Ju~~t~::~fc a~~d ~,ti~•in.4 f'tli•J ~ri11i (7rrk ('irruit ('outt. anJ Jup6::~lr ~.i~b Tax As~ctsur)
' ~ r ~ 224 PAL'E~~~
~ ~ P ~ l~
.,yj~?,_ ~:j M `A'
R ~ .
~"L Y.. a.[ t"r ~ ~ r ~'~..'.:,t~ _
~ . i~
. ~ ~ r -
- . . ::':?~i~'~„^'}: