HomeMy WebLinkAbout2254 D~c~~ratia~ of Dar~ici~~ ~nc~ Cit~~~n~i~4p
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ST. LUCIC--- - . , C't)UN'1'1', I~LOItll)A:
71;is is my clccl:~r:+tion c~f l)onticilc ar~~f ('itir.~n~hi~~ in thr Siatc af Floricla that I am tilii~g this day in
a~cor~lancc, an~l in confcumily with Sertic~n "_2.17, Florid.~ Statulcs.
l was formcrly a Icz:el ~rsidc»t af __~1_~_Ss~ - a, ? and I .
(City) (Slale)
rc,i~lyd at -_---,~~vQ _~s~?r~.~__ 1'~~
~ . Ha~vevcr, I have changed my domicile to
(Strrr! anJ N mAar)
,:»~l am and havc bcrn ~i bona fidc r~sidrnt of the Statc of I~lorida since .,2~- day af
, 19 and 1 nnsidc at ____!Z/ 2 g~•` ~ .
(Slreet and Numbet)
__-f~--~-~~
~
R C ~ COllllty, Florida, ,
(cti~Y)
,
.+nd this statement is to be takrn as my declaraiion of citi7enship, actual irgal residence and domicile in the State
uf Florida. i:
;
(Inseri here any prrtinrnt facts, such as ~Ir of ptoperty or business, or telinquishmen! of employment at former
domicile, removal of family tu new domicile, purchase ot home, rtcJ
~
ENTERING CHILDREN IN SCHOOL; HOMESTEAD EXEMPTIOP~1: ~
s
If entering children in schooi, 4':
;
please list their names: 2~64~6 ~
Pr ~ r'1 ~Q Sh e iZ fILED hti<< 'rECUl3GED
St. tUC:~ C?UN TY FtA_ ~
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CLL"K .U~tCOURT
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MAR I I ~L 55 ~H'7~
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1 FURTHER CERTIFY ti~at l will rc~ister at my local address when the registration books reopen, and -
comply with all oti~cr requirements of a iegal reside~il of this State.
1 rURTHER CERTIF.Y that I h.i~•c no intcntion to return t~ my fonner domicile, and I intend to remain in
FT .}~r cRc ~ ST. LUCIE Count
- , y,
I~ lorida, pe.rmancntly~. (c'`'`) r ;
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. ' 1~t~TA1't7RE ; .
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~ % ~ - _ ~ SIGI3ATURE ;
•
S~vorn•~o and $utisc~iBed befom mr this day of -
^L.
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U ~_`-_k~2 t~lE„/ S •
A.D. 19-- 74--• ~~'aTng 7iddre s
RQGER POITRAS, CI.ERK CIRCUIT COURT =
_ ~-1; J~i r~. c ~ , Florida
By , Q-~-~t-e-L- Cs~oz~'~-~c.~Deputy Clerk
(To hc r~ccutcd in diqnc~alc aud oriy:in:~l (~Ird ~~ilh ('Icrk Circuit Court. and Juplicatc ~.i~h Ta• A~arssor) .
F:~t 224 f~~F~~3
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