HomeMy WebLinkAbout2094 uect~rat ~n ot uo~~cir~ anq t;ttE~:~n~r~cp
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ST. 1.UCIF. - C'pUN~'Y. I~LC)It1UA:
"Il~i; is my clrclaratiun of Uomicilr an~l Citi-r~n.hi~~ ii~ thr Statc of l~lorida that ( am tiling this day in
:~~ronlai~cr. an~l in cani~c~rmity with S~~ction'?,.17, F=lorida Statutrs.
1 was formcrly a Irgal resident of and 1
l~lY) ` ~ ~ (Stslc)
r~~.icied at ~~~~~L_~~-_-_ - tlowcvrr, 1 havc changcd my domicilc to
(St~tet a~d Numbcr)
and am and havc b~cn a bona fide rrsiJent of thc Statc af ~lorida sincc __~-~,~D day ot'
~~~?16~!!!^ - , 19~~, and 1 residc ai : ~~~~~'1Q __1~~'~
(SireN and Number) -
C/~ ~
! T__.,C_.1~1~'i`~ . L i'~ i1`~ County, Florida, :t
(c~~~•~ -
;~nd this statement is to be taken as my declaration of citizenship, actual lega! residence and domicile in the State
ot' Flvrida. {3
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(laseri. hrre an>• pertinent tacts, such as sale of ptuperty or busineu, or teli~yuishment of employment at former
domicilr, removaf of tamily to new• domicile, purchase of home, rtc.) ~
ENTF.RING CNILDRE~t IN SCHOOL: rn HOMESTEAD EXEMPTION: ~ t$
I£ entering chi1dren in school, ~
S • ~
plea e list their names: t
~f
~ F~ ~Sc
~
~~'iT~r ' ''i ~ •'!C1/F~
3Z_ ~J`.. " - 33ttit' FLw. ~
. _ '2A5 ~
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!!u~ 8 11~ 3~ AN'1~
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I FURTNER CERTIFY that I will rc~ister at my local address when the rcgistration books reopen, and
comply with al! other reqtiirements of a le~al residrnt of this State.
' !7
1 FURTHER CERTIFY that I havc no intention to return to my former domicile, and 1 intcnd to remain in
-l
~7- /C~~r ST. LUCIE , County,
E~lorida, permancntly.
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SworN tv ~td suhscribcd-~b~;pre mr this day of ~
- _ ,y~+ ~ _ _ A.D. 19 74__. ~ ~.~..i',E
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~ - 1~ iTng Ac~ - re s s
ROGC~t-'PO~TBA ~ +,~RK C RCU7T COURT
- , Florida
_ • c : r _
By . ` eputy Cl.erl; _
(To br rxrc ; in Juplicatc anJ ~~nf•in.~l filyd «itl~ l'Irtl: ('irctrit ('uurl. anJ duplit:elr ~vilh Tax As~cssu~) .
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