HomeMy WebLinkAbout1738 ve~~~r~~~an oT ~'Qmict;~ V~LdLC:~ ~~i ii~J
~c~ -ritt: s~~~n~rt: nt~u c•oun~r~~ •r.~a nss~.sso~., 2'76158
ST. LUCI~`----- ('UUN~~Y, I~ LUl:ll)A:
'~I~is i~ my dcclaration c~l~ Domi~ilr and Citirrnshi~~ in thr St:~tr uf i~loricta that i am filin~; this day in
.~rror~l.~ncc, and in conl'ormity with Scrtian ",.17, fiorida Statut~s.
.
1 wati fornirrly a Icgal resid~nt of _ - - - and 1
~~r) sute)
rr~icled ~t T~ , ~~-!Yf~ _ . Howcvcr, 1 havc chanbed my domicilc to
(Streel anJ Nu r~)
:?nd am and havc bc~n a hona fdc rrsidcnt of thc Statc ot~ Florida sincc __^~_'zl day af
_ 19~'~ and 1 residc at l~~~'~~ Q e~-
' ~ (Strect and Numbcr) '
;~t~- • ~~-~-1 County, Florida, ~
(c;tr> ; .
S'
.i~~d this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State t~
uf Florida.
,
(Insert here any pertinent tacts, such as salr of property or Ausiness, or rtlinquishment oi employment at former
domicile, ~emoval uf fa~nily to nrw domicile, purchase of home, etc.)
ENTERING CHILDREN Il'd SCHOOL: HOMESTEAD EXEMPTION:
If entering children in school, ~
please list their names:
~ ~ 2'76~.58
F~~fG a+~<<rYcakaEo
~ ST. lUC1E C ~i?K1Y F~~_
A.C;f - • ; 'RAS
CLE~!1 Ci .~L~' `pURT
°c^_~,~^ t•r.-:.-:Ep=~
~ s 11:zs~H ~r~ ~ .
I FUR?HER CERTIFY that I wil! register at my local address when the registration books reopen, and
romply with all other rec~uirements of a Iegal resiJent of this State.
1 FUR?I~GR CERTIFY that 1 have no intcntion to return to my former domicile, and I intcnd to remain in ,
.
~~~~~d (~..-t~ir~c_e./ - - - - , ST. LUCIE , County, ~
Fiorida, perman~:ntly. t~'`,~~
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- - S IGNA 1'UItE
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SK~oni•to antlsuliscri6cd bc~orc mc tl~is day of - -
. ~~_~~1~~ 74 '
; A.I). 19_---• i in > ress ~
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ROGFR POITRAS, CI.ERK CTRCUIT COURT Florida '
_ ,
gy .<<,. ~.L ~,~z i~~ Deptily Cl erk ~
~ : ~24 F~~`7~7 -
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(Tu bc r~.ratrJ ir~ Ju~~lir.~~~• anJ e,ri~inal ldrd i+ill~ f'Irr~ ('?reud ('uurt. and dupli:atr with Tax Asecswr)
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