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HomeMy WebLinkAbout0648 / _ . k ' ~ ::~~~~.~~:~~c~ c~~r ~~~n~ci~~ ~~~c:~°~~~~5~~:f;~ ~i c, ~ri it~. ti~i n~ i~: n.i~ c~c~ur~~,-,~ nx ,,~~~:s~c~it. ,~8s30 ~ s•r. LUCI1. _ cc~uh~~~~~, ~~~.c~izii~f~: ~ ~ ~l~i; i~ my drrlaralic~n c?1~ I)omiz•ilc an~t Citizcn~hi~~ in the Statr of I~Ic~rida tl~:~t I am liling this ~iay in arrunlai~cr, an~l in conl~c?rmity ~vitli S~~rti~~n ~,~.17, f~loridci St;~tut~s. ~ 1 wa• fc~rmcrly a Irral rc~i~l~ nt of - ~~~+c.~21-- _ - , ~ and 1 ~ on (Cit>' ) (slatc) s r.•si~lc~l at ~1 ~-~l_- 5.~-- ~.a~._~~~ -d~`'. . Howc~~cr, I havc changcd nty domicile to ~ (Strrrt :u~d Num?Kr) anii am an~l havr hr~.n a boi~a lidr resiilrnt ol~ th~ Statc o!~ Flc~rida si~ice ____a~~___ day at~ aU,l.~(,~ • - - - , 1 - ~ ~ , an:t 1 rc,iclc :it .~1-- - -~'---~~-n' ' (5lrcet aoJ Numl~r) " _ St . _Lucie County, rlorida, . ZS? c ~..u~ - - ~ cc~„~~ - - - - - ' ::n~l thi~ •tatru~rnt is tc~ hr t:tkrn .is my drelaration of ritizrnshi{~, .~ctu<:1 lcgal residcncc and domicilc in thc Statc uf 1=loricla. (Inxn I~rcr :.n> ~c~ 4in: nl f~~ 1.. ~ucl~ ,s y:~• ~,r r{„r~~~~• huci:~cs., ~.r rcli:~yui~hmcnt uf cmpluymrnt at fotmer do~nicilr, r.m~~~:~i .~f (..mily tu uc~~ dun~~~ilr. puschacr u h~•:,t~. rlc.) i:;1-^^., SCNOOL: HnP~u;STLAD EY~r;P7'TC';: ~ _..~,,,:.7 CEtILDR~:: I. If ert~?'itZg ~1~ilclreli in school, i~le~sc 1 ist thei r i~ai~ies : . ~ ~ ~ ' ' ~ ~ i ~E~ A41 l y.ii~~0 SL LI~~E ~ 3l~d~ ' ROL_ fi Ti+t; R~S ~ZrG•, c:tr:~L'!: CuURT FFr:,F;1 ~F~ -:F[? ; Ju~ 1 1014 AH'15 ~ ; - - ~ ~~o ~ ~ . ; ~ - - ~ ~ ~ 1 f=U1:TIll:P. CF,R"i'IFY ti~:i: !~vi!i rt^i~t:~r ai m~~ 1~~a1 addrex~ ~~fic•n tLe rc~~istration books rco~~cn. ~ind ~ rum~~h~ ~+~~th .ili otL.•r rc~~!~irr:nc~~ts uf a;rg.il r~~iil~•nt ot~ this Stat~. ~ ~ t= •Y th::i I?~a~~.~ no intcnti~,n to rcturn to m}~ fc~rmrr dc~micilc, ancl 1 intrnd to rcmain in ! I- U[ t~ I. t, K c?: i z t t r ~ ~ ~ . ~ S'i . ].'JCIL' ('ounty, ~ - = - ~t_-Lz-~c--Q~ - - - - ~ 1=1c~ri~ta, prrn~anc~~tl~~. (c~~~.; - - - . ~ _ . ~ ' : ~ _ ~ G . - - o - `~r, •~R+s~.fL,i:•., ~ - - - - ~'`~i~ - - - - •q ; • 1.` ~ . Q` • . `y • b : r~a ' ~ ' a. . : ' ~.',t/Q ~L~ : . y . ~ ' I'a . Jj C • ' . _ _ ' . ~ ' ~ ~ _'~;~t~ ~t - ----SIGivhTUltI? ~ ~ '''t:.~s' ~ % c: ~ > ~ f~ ;~~y, 45.~,__. " 4~. E : ~.e~,:r,;~;;;~~''~t1"~(~i~F~~d t,~r~,i~~,i~:• ? t?;i~~ nr ~ i'~ C ~ Fl.,,S~`:i~~~~ ~ ~ 8. ~ .~~t - - - - - • / ~'~~OZ/14 ~ ~ ~^.~9 1 lil~ I C r~'_ : S ~ :r: Pu1"+i?l'ti:;, : l.l:t;i~ ~:T!~`:l?i_i~ ;!rT _~1 ~~o~`~ ~ i lor.i.t~~; ~ - n~;~t,1:~- .ier.~: ~ _ . ~ . ( lu br rtr~~ rJ in J+~pli+ : .m~l ..~..in d t~IrJ ~+~~h l'Ir~1. (~rcuit l'~~wl. anJ Jupfir:.fr ~ci~h Tax Axsccu~r) r~ ~ 800~ ~J5 PAGE V~~ ~ a _ ~ -t - _ _ . _