HomeMy WebLinkAbout2638 ~;~c~ ~r~~tc~il 0~~ i3a`l1lCtt.: a~t~ Ctf ~~e~~h~p . .
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I U': I I l: STATI: ANU ('UUN1'Y '1'AX AtiSI~.SSOtt,
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ST. I.UCIE _ ~•~~~~n'1'Y, I~LORiDA:
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11~it is my dr.claration oi Uomiciir :+~~d Citixcnsliip in thc Sta~t~• ot l~lorid.~ tl~at 1 am Cling this day in
cur~l:~ncc, ai~d in cunforn~itv witl~ Scction 212.17, F~ori~la Statutrs. ~ i+
,Ir r~~_____.._ ~ and 1 '
I w.is formcrly lc~:~l resi~lcnt of L__~~! ~~+Y-` ~s~.~~) `
,.....~.r._ . . (CitY) ~
. However, 1 have changed my„cjivmici~e to
rr:id~cl at~- 3_ -
(Strret and umMr) !~7 i
- day of $ ~
an~i am and liavc Ixcn a bona fidc residrnt of thc Stata of Florid.~ si ~ce
y l~ t.
_ 19 2.~, and 1 residr at o'~-~-~--~--~-- ;
(Street and Numbr~)
. ____St. I.ucie County, Flo~ida, '
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;~n~i ihis ~t.ltCilll'lit IS tU ~C Z.~ket~ as my declaratic~~~ of citizenship, actual legal residence anJ domicile in the State
uf Fl~rida. . ~ '
(inscrt 6erc auY {~rlinrnl fscit, such u s~lr uf pruprrty nr bu~inrss, or relinyuist~ment of cmployment at formcr t•
. _ _ ' ~ .:z.. .......5':c". 'f !'r..^.." II'^"Z
domicite. [rmoral W ~amuY u... ~ ~ -
HILDRFN It; SCHOOI..: HOMESTEAD E' ~MPTIO?::
~_ITER7?.G C ~
T f etltering children in school,
pl ease list thei.r i~ames :
~'7~.~ .
' fIlEO AAG R~CORO p
it.lUCif GOtiMTY i~A,
IiOCE~ F~tTRAS
CLER~ C;;,CUIi COHRt
_ Rf.COa~ vC~!F~ED_~_
o~ rl io ~z i~ ~7~
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I FURT}IER CERTIFY tl~at I will rcgistcr at my local address ~~~hen the registration books reopen. and
compl~~ witl~ all other requir~mcnis ol' a legai tresident of this Statc.
Tt-hirn t(~ 111\' former domicile, and 1 intend to remain in
FUK'l-tl~K ~:i:ic i ir u~a~ . . - - -
ST . LUCI~ County,
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1`1or;~~3e~ma~]t'ntly. ~ tc~~~)
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rti:,~` " ~.•~'`c hcfc~rc m: this ~1_ d.iy of
. Sqtc~r~i'to.and,.~s~,riti d
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- - - A.D. 19 _ 1 Lr.g ress
'.,OGf:R P(~I ~:tf~S, CLE.:K CIRCUIT C4U?T , Florida
~~y~~Deputy Clerk . •
(To br ezr:~ilcd in du~~liralr a;:J ~~rifi~~al 1d~•d ~+ilh Cletk ('ircuit Cnutl. a~tJ duph:ale ~eith Tax Ai~zstx)
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