HomeMy WebLinkAbout2245 Deci~ra~~an af Qa~nic~~~ ar~d Citizer~~h~p '
l i~ 7~111: STA~'1: ANU ('OUN'I~l' '1'A\ ASSI .SSOIt, -
sT. _~.uc1E-- -------~'c~uh~t~ti~, ~~~.c~~~~~~n: 2'~6489
"lliis is my drel;iratiun of Uomirilr c~i~d Citizcnal~i~~ in thr Slat~ af i~lorida that 1 am filin~; this d:?y in ~
.,~rc~rclanc~, c~nd i~~ confonnity ~vith Section 2?2.17, Flo id~ S• tut~s. ~ :
1 was forntrrly a Irgal residcnt of ~ - C~ ~ ~~~_l1~~3::~L' and [
(Cityl (srste)
r~~.i~IrJ .it ___`~~_.~.a . Howcvcr, t havc changed my domicilc to
(Strrrt anJ Numlrcr)
i:
an~i am ;t~~d have bec~i a boita iide residcnt of the State of l~lorida since ay ot~ ~
- ~ , and 1 resid~ at ~ • ' ~5
(StrEet and Nu r) t
t-
_ , ~ County, Florida,
(c~ty~ '
ai~~i this statement is to be taken as my d~c:laration of citizenship, actual tegal rNSidence and domiciie in the State
uC C'lorida.
(Inxri here any prttinrnt faclc, such as sale of property or businrss, or relinyuishment of employment at former ~
domieile, remo+~al of family to new domicile, purchasr of home, rtcJ ,
i
EP~TERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: _
If entering children in school,
please list their names:
~%~~x~t,Le .
ftt~ ~ ~ `-~:j jNTY FLA. ~
ST lU~ - -~AS ~L
Rv ' ~ - ~CllRT `
c~ti, , ~ ~ -
ark has :~.oved to Fort Pierce ~
to make his home with me permatientiy, r`~~~ ~
Nlatt I t !l 3a PM'~~ ;
2'76489 _
. ;
. ;
;
1 FURTtIER CERTIFY that I will register at my locai address whci~ the registration books reopen, and 4=
comply with all other requircments of a 1rga1 resident of this State.
t FURTHER CT: TIFY that I hati•c no intention to rcturn to my forn~er domicilc, and I intend to remain in
ST. LUCIE i~
- - , - , County, ; ~
I~lorida, pcrmancntly. 1~
- 'n;'• v .'?,Q~iI
~ - 's~
. ~tl~~er~ 1
. . . - - -
~ - ' S IGI~1A~ru~
: Y • Y~ ~
S~t~orn.to an -i~li~~ cd bcfore me this da}~ of - -
~
- - - , n.n. ~ ~ _ 74 :
- i ing c ress
ROGCR POITRAS, CLF.F~F: IRCL'IT COURT ~
_ _ , Florida
Iiy Dep~.ity Cl erk
(To hr ca IcJ in durlic~tc anJ ~~n}:in,J fd.•d ~+ith t'Irtk ('ircuil Cnurl. and dupliratc wilh Ta? Asscssor)
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