HomeMy WebLinkAbout2448 Decla~a~ion of LomicEl~ a~d C~~~ze~~hi~
~ c, ~~i~: srn~i~t: n~u c•c~uti-i TA\ AtiSt.SSOIt. 2'766S2
ST. 1.UCIE - - - ('C)UN'1'Y, I~ LOItIUA:
"fl~is is my ~lrclaration c~f l)omirilr and Citinnshi~~ in thr Statr of rlarida that t am filii~g this day in
:~~~c~r~lancc, anct in conlormitv ~vith Scrtion ,~,.t7, Florida Statutrs.
:
I was fonncrly a Ic~,al residri~t ~f --_---~:-~,~..rs.1~ ~ and 1
(Ci~Y) statr)
r~•~id~d at __-~.~:~'_~<~~Q~__ __A. Ho~vever. 1 have changcd my domicile to
(Street aoJ Numbrr)
an~l am and havc b~rn a bona fidr rrsidrnt of thc Statc of l~lorida since ~r~ day oi'
6 ~ ~ ~
sT ;
, 1 I-- , and 1 residc at _ _
, (Streel and Numberl
_E,~Cf ,-S~ LlJCi _f Cour.ty, Florida, 4
~c~~r)
- t
.~nd this statement is to be takcn as my declaralion of citizenship, actual legal residence and domicilr in the State
of Ftorida. `
Qnseri hcrc any prrtinrnt [acls, sueh as sale of pruprrty or Dusinrss, or relinyuishmcnt of emplayment at former
domicile, remo~al of family lo new domicile, putchase ot home, etc.)
S
ErITERING CHILDREN IN SCHOOL: ~ HOMESTEAD EXEMPTION: ~
If entering children in school,
please list their names:
_~~L~~ N (i~ i~ i~' ,G~EA~/I
~ 2~ss52
fILfL" r,~• ~
ST. ~uc :~~i-kir fE0
R~~:: LA. •
°~~C
~~~yr-~ ~
+RT
; ~ Ma~ , ~
11 3 4o FH 7~!
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' 1 FURTHER CERTII=Y that I will rerister at my local address when ti~e registration books reopen, and +
; romply with all other req!~irements of a le~al residrnt of this State. t
~
1 FURTHER CERTIFY that 1 ha~•c no int~nlioit to return to m~~ tormcr domicitc, and ~ intcnd to rcmain in
; •
` _ ~
~ ~ ST . LUCIE , County,
~ f~ lorida, pcrmancntly. ' (c''t"~ 1
, DA~.TY EN ~
~ -
~
_ . o ~NA ~
- . : < ~~'_~~~J'~ _
~ S IGI~ATUR~ i
i S~vortt td ~11ac~.subsCr+fkd~bcf~rr mc this ~1,~y oC -
~
~ ~7~ `
_ - - A.D. 19 _ 74_
ai ing ress
RnGCR P0ITRAS, CLrRK CIRCUIT COUItT
- - , Florida
~y ~~~~.._.L CvoZ 1~~J7 Dep»ty C] erk
(Tu bc rxeculyd in ~tupl~.rtc :md ori,•in:d tdrd :tiith l7rtA ('irc~~it ('nurl. and duplica~r Ni~h Tr~ Ascc~tnr) ,
2~4 f~~E~447:
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