HomeMy WebLinkAbout2887 Dectar~~ion of Qomicite a~d C~~izenship
I c~ "t itl: S'I~A'TI: ANU C'UUN'I'1' 7~~~\ ASSI:SSUtt,
ST.^LUCIE -~,~~UN1'Y, r•~o~t~ut~: 2'76968 3
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Tl~is is my drrlaratio» of Domicik and Cilixcn~hi~~ in thc Statc of I~lorida that 1 am filinb this day in ;
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arrc~r~lanc~, and in conCormity with Srctiun 222.17, Florida Stahites.
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1 was fonnrrly a Icgal rcsidcnt af __~v~_~~~~~- , Iv and 1 ;
(City) (Sta1e) ~
r~•sidcd at ~~r~~~~_.~~^
l-T-_ . Howcvcr, 1 havc changed my domicilc to
(Street and IVuml,er) ` ~
a~~~d am and havc bcen ~ bon~e r,a~ nsidcnt of llic State of Florida since _ ~ day of
_
- , 19 and 1 residc at ~~'~TM D ~ ~ /~~T~~~ '
i:
(Street and Number) ~
_ _ ~~~~L G~ , ST ~ ~/G! ~ County, Florida,
(City) - ~
:+nd this statement is 1o be taken as my declaration of citizenship, actual legal residence and domicile in the State {
of Florida.
(lnsrrt hetr any pertinrnt facts, such as sale~of prupetty or business, or relinquishment ot employment at formet
domicilr, temoral of family to new dumicile, purchase ot home, rtc.) g
ENTERING CHILDREN IN SCHOOL: ~ NOMESTEAD EX~MPTION: '
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If entering_children in school, ;
please list their names: '
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. I~r
FflEt a~t -~=Ci~!iaEO . =
St_ lU~.' ::~~R11 FU. 1~
- Ct`Rl;.~ . -~~5 `
4cr-, _~~J;' vOURT
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MaR IS 11 s2 AN'7~1 ,
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I FURTHER CERTIFY that 1~vill register at my loral address whcn the registration boaks reopen, and ~
` comply with all other reyuirements of a legal resident of this State.
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I FURTHER CLRTIFY t I ha~c no intention to return to my fornicr domicile, and I intcnd to remain in ~
; ~ ST. LUCIE County,
_ , ,
~ t=lorida, pcrmanently. <<~'~''~
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• -•f ~ SIGIIATUItC
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S~ti•9r~:~o ~Jid sub Erib~~~1s_c?`ore mc thi~ _~~ifay of -
: n.n. ~ 74__. ~ ~ ~ ~
_`q " - i ~~'are s s `
~OGC1t~,PA~~~'~~;~CI1:EtK CT.RCUIT COUR'1' :
, Florida i
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IIy G~ Deputy C] E~rk ~ t
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# (To bc racc 1~•J in duptic~tc anJ u~iy~~n.J fArJ ~vU~ (7.rk ('ircuit t'ourf. anJ duplicate ~+ith 7aa Acxsscx) .
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s ' 224 P~,~~ 2885
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