HomeMy WebLinkAbout2709 Dec~~raiE~n af Da~~ici~~ and Citizen~E~~~
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"IU "1'ill: S7~Al~l: ANI) CUUN7'Y "1'A\ ASSI~.SSt)It.
ST. LUCIF_ _ COtlN"i'Y, i~LOttll)A:
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~l~i, is my d~ct;~r,~tion ol~ I)omic+le ane! Citizrnsl~ip in the Statr of florida that 1 am tilinfi this day in
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,~ccorclaitc~, ~~nd in conformity ~vith Section ~22.17, Florida Statutcs. ~
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1 was ft~rmcrly a Irgal r~sidrnt af _~t~~_~ht~,C~- ,~cr? ~CRSr ~ and 1 ;
(cily) (state> :4
r~~idcd at 6Z UQ~~i~~tt~_-_ . tiowever, I 1~ave changcd my domicilc to ~
(Strert a~J Number) ~
and am and have bren a bona fide residre~t of the Sta2e of rlorida sinca~ a~ day of
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_~L~ uA _ , 19 7~"'~ , and 1 residc at a~SSRND/A ~i
t/L~'
~~1/ ~i"s
(Street and Number) 4j
PO /2 T ~Z v c i ~ . ~ ? c / & County, Florida, - `
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a~id this statement is to be taken as my decl;?ration of citizensliip, actual legal residence and damicile in the State ~
of' l~ lorida.
(lasert here any prrlinent facts, such u sale of property or businrss, or relinqnishment of employment at formet
domicile, ?emoval ~f t~mily to new domicile, purchase ot home, etc.)
ENTERING CHILDRE?J IN SCHOOL: HOMESTEAD EXEMPTION: ~ ~
If entering children in school, ~
please list their names;
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~ FtLEC~ !•h:_'~~~3?~DED VA
ST. V}C;= ~,~U?~tY FLA. • =
RO,~ ti; : ~~TRAS ~
ClE:;r ~-~tT COURT 3
Af.Cf:f:ti F ~ ~
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I FURTIiER CERTIFY that I witi rrgister at my local address when the registration books reopen, and
~ comply with al! other rcq~iirements of a Irgal mside~it of this State.
~ I FURTHER CEItT1FY that 1 havc no intention to return to my former domicile, and I intend to remain in
~ ST. LUCIE
~ Pu rLT ~'-r ~ i t_ , co,~~zty,
E Florida, permancntly.
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# Sw~~and subs 'ttCd=berorc mc this __L'~ day ~t -
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74 g.f~S c~ q.VDi iq ~v6 ~i-v j
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- - .D. 19~- ,
_ ~ , . i ~ ~ - i ing re s s :
r ROGE~''PO'!'1'RAS, CL~RK CIR 7T COURT t~
~ ~ ST ~C.uc i~ , Florida
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` ]3y eputy Clerk
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~ (Tu he exe leJ in Juphcatr -rnJ otiginal tilyd ~vi~h ('Icrk ('ircuit Cnurt, anJ duplicalr Kith Tax Asccasot)
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