HomeMy WebLinkAbout1841 veciara~~on oT vomici~e anc~ ~~N
TU TlIE STATG ANU C'UUNTY ~'AX ASSL:SSOR, .
ST. LUCIE ~~~~~~1
_ COUNTY, FLORtDA:
This is my dcciaration of Domicilt and Citizenship in the Statc of Florida that 1 am filing this day in
accordance, and in conformity with Section 222.17, Fiorida Statutes.~ ~
1 was formerly a Icgal residcnt af T v~T A/~T~v~ ~ , ~~~AS and 1
(cKr) (Stace) ~
resided at 3.~ o G 1~~~ . However, I have changed my domicile to
(St~eet a~d Number)
~
and am and have been a bona iide reside~t of the State of Florida since t~ day of
, _
, 19 and I reside at `
(Stteet snd NumOet)
a'~ _ _ County, Florida, `
(Citr) ~ i
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State
of Florida.
(Insett hete any pertinent fscts, such as ule o( propMr or business, or « linquishment ot employmrnt at tormer
domic0e. remorsl of tamilr to new domicJe, putchsse ~t Aome, etc.)
ENTERING CHILDREN IN SGHOOL: ~ HOMESTE~+?D EXEMPTION: ~
If entering children in school,
please list their names: -
• A~`~ •
FtLED 1?MG REt;pRQEp V' '
_ _ St. lUC1E )~T~y:p~.
RGG== =:^,tTR~S ,
- CLEFK C; ;;UIT ~01}~ 1
R F ~ Ci L~ V= f tE0
+~t. J1 11 oa aH'1~1
~ _ 2~~;~
1~.
~
I FURTHER CERTIFY that t will register at my local address when the registration books reopen, and
comply with all other requirements of a legal resid'ent of this State. _
I FURTHER C TIFY that I have no intention to return to my former domicile, and I intend to remain in ~
~
ST. LUCIE ~
~1 / ~~f~~ , ~County,
Florida, permanently.
` # _ ~ ~ • -
. ~ ~ ~ ~ .
. " "~'Y. ~ :
'~~L''~ C •,L- ~
~ . - ~E~f~ 1 ~l~ ~~a k S Y
- ~ ' ' . • .
- =Y~;=
: :•~Z_ . . . r,3,- .
Sworn,t~ a~d sul~scrlli~fore me this day of
= . r s.
_ A.D. 19 74 -
~B~ , Florida
R ~ .
. ' .
gy , ~ l~~Deputy Clerk
~
aoo~c~i~ ~ . ~ _ ,
- _ _ . -
_'r,..-..._,.. _ . -r ~~~~_wt.-.
'y~~~'''zy' A't"~ ".`'~.~ts~.~ •i ' _ . " _ _
~ ~
_ '
. . _ _ . _ ~ "..,3 _ _