HomeMy WebLinkAbout1476 Dectarafi;on c~f DQmicit~ ~n~ L~~~~~n~n~p
~ro -riiE: s"I'ATt~ ANU (~ouN~r~~ ~~nx nsscsso~~, ;~'~g~~8
ST._ LUCIE CUUNTY,I=LORIUA:
Tliis is m~~ d~cl~ratiun of Damicilc cu~d Citi•r.cnsl~ip in thc Statc of florida that I am filin~; this day in
accor~ancc, and in cc~nformity with Scction ~22.17, Florid'•1 St1fUICS. ~ .
i was formcrly a lcgal residcnt of and 1
(ci~r) (sute)
resi~icd at ~'0~-- - Howcvcr, I havc changed my domicile to
(St~eet and Number)
and am and have been a bona Gde nsident of the State ot l~lorida since ~ s~ day of
~
, 19~,~., and 1 residc at 3
- (Strcet an umbet)
_ r__/ ~~1~,-~ Q St . Luc ie County, Florida,
[t~- . -
(c~tr)
and ihis statement is to be taken as my declaration of citizenship, actuai legal residence and domicile in the State
of Florida. . _
(Inserl here any pe~linent facls, such u sale of pruper~y or business, or relinquishrneot of employment st formrr
domicile~ remo~al of family to new domicile, purchase ot home, etr.)
ENTER?~jG, CHILDREN IN SCHOOL: ~ HOMES'TEAD EXEMPTION: _
I£ entering children in school,
please list their names:
Fw~ ~ ~k ; F ~ a~rfe
57.Lli~i: -.~:~?TY flA.
RC t =Ui~~l1S ~
r! G~:~, i.. ~ vJ~T C08Rt
• aF~f ,;r. _ f ^
, Ml~c C9 2 i4 PM'~~t
; - _ .
~
~
~ 2'78~U~i8
,
1 FURTHER CERTIFY that I will register at m~~ local :iddrrss „~hen the registration books reopen, and
comply witl~ ai! othcr requirements of a Icg:+l resident ot this State.
I FURTHER CERT Y that I ha~•e no intention to return to my fornier domicile, and I intend to remain in
' ST, LUCIE County,
,
,
Fl~rida, pcrmanently. ~ ~ ~~''y~
.
I '
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~ ' ;b~=~ Ci' y: - -
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` ' - - S IGI~IATURE
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~'~c.~' g • ^•j ' yf;.~.
'~k~ ' ~ ~
~ Swnr~f~o, a~t~l•s b~c :flefore me th~s day of .
l .~b . _ ~
~ . ~ 74 ~v ~ er~
~ ~~~~~:~«4 n.n. . ~ .
~ - - , - - i ing ~ c re ~ s v~e
~ ~ .
~ P.OGE:t P(??TRAS, CL~RK CIi'.'~ 'T COU :T , Florid~a~
~rnE~~
~y , ne~ ~y (:1~~ ~t:
(To bc e~rculrJ in Jupli..+ic .md ~itiginal (ilyd ~rilh C:rrk Circ:~il Cnu~l. anJ duylicale Kilh Tar Ac,ussor)
oCCI . PA~,
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