HomeMy WebLinkAbout2130 Q~clu~atia~~ of Dor~~ ~i~~ ~nd CitizcnsF~:~
~t iu~ s•rn~~i~. ,~~u c•c~u~~~ ~rn~ ,~ssi:ssc~ii. 2'75416
s'r. ~.ucz~: _ _ c•c~uNi~~~, i~~.c~ii~un:
"Il~is is my ~trclaralic~n c~f vomicil~ anc! ('itiic+~shi~~ in !!ir Stalc c~f l~lorida tliat I am filin~ this ~lay in
:,~~c~r~l.~ncr. an~l in co~~farmity witl~ Srrtion ,,,.17, l~lorida Statutrs.
. _ ~ / ~'~~~c• /rs~ ,
1 ~vas formrrly ,i k~.al resident of , _ -~_C' . • and 1
- (Citr) (state)
1~'~Il~l'() ll~ - Lj~G' _--=/~_/j Cd • ~ .
_ ~,1 . liowrvcr, 1 ha~•c changcd my domicilc to
(Strc~t anJ Number)
an~i an~ and havr becn a bona ~de rrsident oF the Stai~ af F~lorida since day o1
_ (~.L~ -c'-~ _ , ~ 9_ ~3, and 1 residc at 1l~__~•~i''~s ~~1" !~it . ./l~
` (Stteet and Number) '
~ , S~ ~ ,J~°.~ ~ .Li , _ ~Gr c"~ Cotmty, Fiorida,
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: nd ihis statement is ta be taken as n~y dcclaration of citizenship, actual lcgal residencc and domicile in the State
ut' Ftorida. ; ;
S~;
~ t~
(Insert herr any perlinrot facts, such as s:wle of pruperty o~ businrss, or rilinquishment of employment at former
domicile, remava! of tamily to ne~v domicile, purchue of home, eteJ ' r
ENT~RING CHILDRE?3 IN SCHOOL: HOMESTEAD EXEMPTION:
If entering children in school, ~ #
1.
please list their names:
. ~ ~f~~% ~~/~s/~-~ 2'~fi<~1f~ . -
F~~ea : ::E.,,~oEo
~ sr.~u~!, ~curi~rFU_ i- =
O p f.Lc~: rV ~±;lT C URT
~C'_
M~ 8 115s PH'7~- f ~
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.
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1 FURTHEK CERTIFY that I wil! re,~ister at my local address ~ti~hen the rc~istration books reo~~en, and
comply ~vith all other req!~irements of a Iegal resident of this State.
4~
1 FURTHrR CERTI[~ that 1 havr no intention to return to my former domicile, and I intend to remain in
t ~__a_ ST. LUCIE County,
(c~iy~ - - • s:
}~lorida, pcrmancntly.
- . . . n C ~ ~ i ~1-~-~fzc - ~ :
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:i . , ~ _ :i .
~ ~w : . ` . _ : - ~ G ~~ke y1 _
- ° ~ SIGi1ATUR~
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S~ti~un~Yo:and•sutr~,eri~cdbrfor~ mc this __O day of
- - l~~~-~~ A.D. 19__74_
ROGrR POITRAS, CLERK CIRCUIT COUR"f ' 1 l~~g c, ress
- - . , Florida -
B Depu':y Clerk
(Tu hc c~ccutrd in d~q~l~calr rnd nn~inrl fdcd ~cilh l'Icrk ('ircu~~ C'ourt. anJ dupGratc ~vilh Tac Acx~~u~) •
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