HomeMy WebLinkAbout2491 l~e~~~ra~~fl~- c~~ ~~:~ici;~ ~i ~~~i~~~~h~g~
c, -r~n: s-rn•ri: n~.n couN'1'Y 7'AX ASSI:SSUk, ~ ~~866 ~
S'r. LtICIL - COUN~'Y, f~LURIDA: ~
_ - - - - ~ ~
;
'fl~is is my ~I~:claratiun of uomicilc und Citii~n~hi~, in thc Statr of florida that 1 am filing this. day in ~
;
accorJancc. :uid in conformity ~vith Scctiun 2'2.17, F orida Statutcs.
F~.[~.~~- _ Cl~c~ and 1 ~ t
1 was foriucrly a Icgal tesidcnt o ~
(slate)
(Ci1Y1
r~sieicd a~ f~ -~1~._~-- . 5=~--=- N~ . liowcvcr, I have chan~;ed my domicile to >
- !
(6trert and Number) •
and am anc~ havc bcen a bona tidc residcnt of thc St:ric of T~lorida ~i~ice L daY of s~
_ ~ a3~''- ~~1'~L f
l 9~ 7 .~C - - :
~it~,~~~~--- + , illl(i ~ Tl'SI(~l' ill _ . i.
(Strret and Numbcr)
~ S~ . Lucie _ County, Florida,
(C~h~)
::"~t t1~ic ctatcmcnt i~ to be taken as my deciaration af citi•r.ensl~ip, actual legal rc~idcnce and domicilc in the State ~
c~f ?~lorida. _ _ - - - - - . _
(Inser: he~e any prrtin~ nl facts, sach u salt of pn~pcrty or bu>i~iess, or retinyui.F~ment of rmpioymrnt at. fotmet
domicilc. ~emu~•al uf tamily to uc~v domicilr. purchase oi hume, eteJ -
. , t . HOr~:S`I'EAD EXEriPTIO?t : ~ ~
}::~:'I'L't T:<~ CII ILaR~:~ IN SCHOOL .
If en~ering children in school, ~---1 ~ _
please list :.heir names: ~
. . ~w~ ~
. ss ~
~ f a ~~r~ ~fco
- - s~~vc,~ c~u~rt~~--
' CLfRK Ci3~
~ir~A:~M
_ R~-:;~,xr vF.a+~i~p -
,
. - ~ 1~ s~ ~t!'l~
~
- T
'
~
~
! '
1 FURTHl:R CERT[FY that 1 wi!1 rc,~ister at my local addmss wh~n the registration books reopen, and
cc~mply with all other req!~irements of a lc~al r~:sident of tl~is State.
I FURTHI;R CERT[1=Y that 1 ha~•~ no intcntion to rciurn to my fonner domicile, and I intcnd to rci~~ain i!~
A~G~ ~~__~_~-d~~-~ ~-S i . LUCI_E _ , County,
t=lorida, pcrm~ncntly. (c~"'~~ - '
J,•.. .C~C~,, .
: ~,q~':.
= . .t . . -
-.ti:'; `~~1• ~c.' ~ ~
~ : C ) '
~ ~ '
. ~ . _ ~ ":<<' ~ ~ _ - ~ - -IGlvtij'URI: =
: ~ , : . `
V'~ s,•4 j' ~ • • . ~ .
i.~~+.
Swor+~,t'q • .suhsrdb~tf'b~:forc mc ti~is _'Z- ~l:ty of
~ ~ 74 ! .
, A. D. 1 - •
-~t ing res~~
~OC~R POI'~RAS, CI.~I:K CII:CL'IT COU]?T orid~
~ ~ ~
}3Y ~ rieputi}~ Cl_er~; .
(Tu tw cxrculcd in Jupt~r•r~e ru.! uri~n~al fi~: J~~ilh ('Irtk ('ireuil Cnt~rt. ar.d Jup5~a1C ~~'11h T~x A•k~`aK)
600K ~A~,~ z~a~
~::~F : = _ _ - ,
~:w
- - ~
_ _ _ _ .w _ _ ~ ~ . ~ - - - ~ ~