HomeMy WebLinkAbout2157 D~clar~t~on of Dor~icil~ G~d Citizc~s~i~
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IO 7 lfl: S"T~Al~li AI~U ('OUN"I~1' ~'A\ ASSI:SSOIt, -
ST. LUC1E - ~•~)UN'I'Y, I~LURII)A:
Tl~is is my drelar,~tiun ol~ Domirilr an~t Citiiri~~hir in thr Stat~~ ~f (~lorida ih.it I;~m filinF this day in
a«or~lancc, and in conformity with Scction 22~.17, Florid.t Statut~s. ~
.
1 w~s forn~rrly a Icga) rcsidci of - - - and I
~~-~~Y) (State) '
r~~sidrd at ._.-~Ls-="-'''_:~ . Howcvrr, 1 have changcd my domicilc to
(Strect anJ Numbrr)
an~1 am and havc been a bona tide resident of the State of I~lor' a since 1~.~.~< day of
_ , 19 and t msidc at ~'KJ i~C~'/ ~
~ et ~nd umber) '
, County, Florida,
(C~~r)
I;
::nd lliis staiement is to be t~ken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
;
(Inurt he~e any pertinent facts, such as sale uf property or busineu, or relinquishment of employmenl at former ~
domicilr, removal of tamity to new domicite, purchace of home, etcJ
ENTERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION:
~ 7
If entering children in school,
please list their names:
i
2"''~' -
/ Jc~`;7 ?
~i ~cs
FILE' ~ti~ ?E~p~pE ~
ST.IU~;: ; :i~N7T FLA.
C{ En'R.:i • ~1'?4S V
~ct•.' : , ~ ul"i LOURt `~G~ .
r{: - :;y~.~
!~R @ 2 s2 PH 'T~I
3
,
-
,
I FURTEIER CERTIFY that I will rc,,istcr at my local address whrn tlie rcgistration booJ:s rcopcn, and
comply with all other req~aircmcnts of a Icgal resideiit of ~his State. 1:
I;
I FURTHCR ERTIFY that 1 hat•c no intriition io return to my fonner donticilc, ancl 1 intcn to rcmain in
. ~
ST. LUCI~ "
, County,
Florida, pcrmanc~ztly. (~'`y~ ~
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. ~ . . ~ . . - - _ ~
: _ ~ S GIJATU ~ W ~ ;.~o l S} - -
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~~vorn to and subscrbcd bcforc mc this ____V__ day o:~ -
--~--,0~<G~'~ A. D. 19 _ 74. ~ ~
i ing c ress
ROGER POIT~AS, CI,I;RK CIKCUIT CGURT Florida '
_ ,
~ ~ -
i3 C:~~~~~~-%~Deputy Clerk
(To br rsrculrJ in Ju~li: alc and ~~tiyin.d fdcJ ~ ilh C'Irrk ('ircud ('uurt, and dupliratc ~ciN~ 7ax Askcwr)
224 Pr,~~2156 :
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