HomeMy WebLinkAbout2361 .
D~clar~~ion of Qamic~~e ~~d Citize~~i ~
~ u ~r~i~: n-rl~ ~nni~ c~c~u~~~ ~rnx .~ssi .s~uii. 2'76S'7~
ST. 1.UCI1?-- ('OUN'1'1', I~LOitll)A: ~
"17;is is nry ~Irclaraliun uf I)onticilr .~nd ('ilizcnshi~~ in thr Statr vf I~ic~rid:~ th.+t i am fili~i~; this day in
a«c?r~lancr, an~t in c~~nl'ormit~~ with S~rtic?n i 7, ~~loriila St,~t~rtrs.
, ~
1 was fonnrrly a Ir~:tl rrsid~~~t of -r-l~-Lq~~ , --R~-- and 1
(a~r~/~ (s~ )
r~,i~lyd at _~1~...~_~--,r~~~~~~~. ~ Howcvcr. 1 havc changed my dan~icil~ to .
(Slrrrl anJ Numbcr)
a~~d am •~nd havc been a bc~n~ fide resi~rnt of the State of rlorida since day of
, 19_ attd 1 residc at ~~-P~l~_~~t~
~tc ~ ~ `_--_.~!~L!L--_ ~Strert and Numbe~) ' ,
~ k. ,~~x n ~~,~,_~~w-o~ County Florida ~ ~
(c;~y) i:
,
,s??el this statement is to be taken as my declaration of citirenship, actual iegal residence and domicile in the State `
o! Florida.
(Inserl here any prrtinrM facls, such u s:+lr ai pruperty or busiriess, or celinquishment of emptoyment at totme~
domicile, temmal of famity to ne~~ domicite, p~rrhase u( homr, ~~c.) ,
ENTERING CHILDRE!Y IN SCHOOL: HOMES'TEAD EXEr1PTI0N: '
If entering children in school, ~
please list their nar~es: Fi~~c ~w`: ~CCORDED
ST LUG~E %~L'H~T fCA.
ROG~ ~ i ~~~TRAS
CI F.~?, C ~~UI~ COURT ~
FfCr:';•'~' ~,=n ~
MlaR 11 l 25PN'~~I r
- 2'7b5'71 •
;
~ G~~ ~~L l~ ~
; c~ _ - ~
; ~ a~t ~ / 9 `7/. ~~~~1 ~~mc- G~y?z.~~ ~ t
/ ~ ~ / q 7' ~~a.~`~-~~ ~L r`~~ `
, ~
E ~ ~~a ~ o.~~ ~a ,
O d~
~ ~
~
~ I FURTHER CERTIC
Y that 1 N~ill re~istcr at tny local address ~vhen the registration books reopen, and
~
romply with all other requirements of a icgal rrsident of this State. ~
4
~ I FURTI'iER~~~'RTIFY that t havc no intcntion to rcturn to my fornier domicilc, and I intci~d to rrmain in ~
~ ~ ' ST. LUCIE 3
~ . . , ~ . , Cow~ty,
I~lorlda,:pirmanc~~tly..; ~c~~y> ~ ~E'~'t~.~N - Gre.~.~rN~) ~
_
- • ; , : _ ~
. . '.;.i , ~ui~.~,~_ , ~5 ~r ~-a ~
` j..• • ;.ti~ . . j
_ ' ,Y _ ~
~ ~ . , . ` , : . ~ ~~~~~~?~22 ~
- S IG:~IATUR~ - a
:
S~ti•orn to and suhscribed hcforc mc this day of ~ - j.
,
74
~~2G - - - A. D. 19 - ~~~i ~n ~ ~ re
s s ~iA~f ~ ~
ROGCR POITRIIS, C1.r CIRCU7T (;OURT g
- _~_G~~, Florida .
Py Deput-y Cl erk ~
' (T~~ hr ea u1cJ in du~~6: :~tr ~uJ uri^ii~.~l fJrd ~cith t'Irr~. ('ircuil ('ourl. and Juplicrtr w•ilh Ta~ As~cssor) .
E_~t 224 PA~E2 360
~ y 4
6~~+~w-~• ~ , ~
C~,'~~~ .r ° ' - a - a.
.t~-ai-c t ~ ~sa, ~;Y u„^ _
x,r.,'~".",rr5:: ~^9--..~'.~:~:~' s. t Y~'~ ~
~ ~a~:~