HomeMy WebLinkAbout2102 af ~oc~~;~EZ~ ~l1t~ ~i~t~~~1~~~~p _
- 29'755'7 ~
~i u•ci i~: s~rn'['i. nNU c~uh'rv 'rnx nss~~s~ott, _
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sT. Luc7~ couh~~Y, r•~ok~n~: . ~
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'l7us is my dccl:ir:ttiun of U~~micilc .u~d Citixcnshi~~ in the Statc uP Florida ihat 1 ant filin~ this day in
;2
~ n.._........ . . . 13
:ICI'Oft~:111C1:, ~nd in c~ntarm~ty witi? ~cc~iun i•.~. t+, j ~Ui i~~u u..~i~:...~. ~
,,,~i~ .~L~Q1_~3 and 1 ~ ~
1 was fomicrly a Icgal resiJent of -.~I\SL~.t~--~-L~-L'-~--_---_ ~s~,~~~
(c~ty)
0~ ~ 4~ . ~Iowcvct, 1 hav~ chaitigcd my domicile !e
: ~idcd at , ~ , ~
r (Stcect anJ Numlxr) 'S
;u~ci am and h:tve been bona fidc nsidi+~t of ihe St:ste of fiorida since ~ day of
t
, 19-~-~ and 1 rrsidc at ~~~s_~~.~ ~~l~~fl N~
(Sueet snd Numbcr) ~ ~
' St. LUCie County, Florida,
Y'~1_E_~-----
:_nd tl~is statcment is to be taken as my dcclar~~ticm of citizenship, actual le~al residcnce and domicile in the 5tate i
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(Inseri here an~• p~slnrnt factt, ~ueh a~ ar!e of PrUPcrty w businrss, or rclinquishn?ent of employmenl at former
dornicle. rrmovaf ot famity. tu n~~+ domecile, pw~Aase ot I~u~ne, ete.)
. HO1~~S'I'EAD EXEhfPT70:: D
E~~TL~tIUG CHILDRE.1 7t: SCHOGL. ~ .
If entering children in school, ~~=-j
pl_ease list tliei.r names : ~
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~.~c ~ ~ n A A N ~l _
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29'755'7 ~ ~
~ FIlEO ANO RECORDEp
~ ST.lUC1E COUMtY flA.
f RQCER POITRAS
; CLERK Ci~CU1T COUAT
i RECOR~ {Ef?161E0~..~.~.-.~
~ O~c 19 12 is PM-' ~I
I
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1 FURTHER CERTIT'Y that I wiil register at my local address ~vhen t1:e rcgistratioii books reopen, a~id
c~mply with all other rec~uiren~ents of a legal Yeside~~t of this State.
1 FURTt1ER CERTII=Y tha.t 1 have no intention to reti~m to m~T tornier domicilc, and I intend io rcmain in
- ST . LUC7~ County,
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i~ lorida. Permancntly. (c'~r)
,
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L. •..Sr.~ ~ -
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. • ; : ~ ~ S IGNATURE
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.~wUrn to~anci rut~~t#1xd~bcfore me this ~ day of
A.D. 19 74_-• ~ing~7c
c res~~
;tOGER POITRAS, ~I EItK ~I?:CUIT fO~~tT~ , rlori~a
gy ~,~,~rG b~-~-~~~~~ Deputy Clerk . ' •
(7u be excculed in du{•1?r~tr ~nJ o~i~in ~i (dcd „ilh (l.ek Citc~it Ca~url. and Ju, licale N~th Tax Asvrasor)
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