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HomeMy WebLinkAbout2625 / " • `f ~ t~E~~ ~~t~J~~~€~~ o~ [~~~~i~i'~~ ~~:~~~~r~~t~~€~ _ i . i ! i d ~ } ~rc~ ~r~~t: s~rn~~i~: n?.n c-oun~ ~r,~x ,~ssi.ssc~it. ~300703 ST 1.UC11: . ~ - - - - - - _ . COUN~I'Y. I'1_URI UA: ~ Tl~is is m~~ d~:clai:~lii~n ol' Do~nicilc and C'itir.~•n.hip ii~ thc Statr c~f I~luiida that 1.~m tilin~: this day in :~c~~uniancc, ~~ncl in ;~unri~nnity ~vitli Sectioi~ ?'2.17, 1=lurida Statut~s. 1 ~vas t~ormrrlt~ .1 Icca1 residrnt c?f _ ~_r~~11. , _ and 1 (c~~Y) (s~~~c) rrsi~icd at __~~'T~ ~ d-~ ~~-7--------.-- . l~awcver, 1 havc chanbrd my domicil~ lo (Strcct and I~umbcrj ~ and am and havr Ixcn a Uona iidc rrsidcnt of thc Statc c~f l~lorida sincc _~~'_L~~ day of ~ , 19_~S, and 1 residr at O 5- ~l_~.~' S~~ _ - ~ (Slrcrt and Numbr~) ~ G..~ St . Lucze _ Count C'lori~la, - . - _ y~ <<~~,~, ::nd thiti statemenl is to h. t~~ken as my dc;daration of citi~enslii~~, actual leg~l r~sidenee a»d Jomicile in the Statr uf I~lorid~t. ~ (Inuri hrr~ •r~~1' ~~rrtinrnt facts, suc!~ •r: salr uf ~•ruperty o~ businres, or relinyui..lunent of empluymeut at tormer domicil., rcn:~ival uf familr Io nc~v domicilc, purch~~e uf hc•mc. ctc.) .,T ~ ~ ~ ~i I;1 SCEIOOI.: HOhiCS'r~AD E\E:~:PTIO'.'i : ~ E~+.LRI:,C; CHILt~2L. ~ If ei.terin~; chi?_dren in sciiool, : please 1 ist t.he~ r nar~es : ~e..!"~~~ ~ x ~vn/ Hd , i . a~~ac ~~ac~ s+a~ ~ • x~C~RD vfxFf£~ ~ ~ ~ ~ ~ ~'~5 ; ; i ; ~ 3U0243 : ~ ~ ~ ~ I I~UKTI~FI~ C'I~RTI[=Y that I~r•ill m;,ister at my local addr~ss ~~•h~n the rcgittration Uooks reo~cn, and roii~~~ly ~vith aU ot'.ier rcc!!iirrmcnis of a lc~al rrsi~fcnt of this Statr. 1 HURTIlI;i: CI:It7'li-l' th:?t I ha~~c no ii~trntion to rcturn to my fonner domicilc, an~l 1 ir.tcnd to rcmain in - ~ S'I . LC'C I~ f 0 r ~ r~ L~------ County, l~lorida. p~ ~'li~fif (c~~~~ _ - - - ~ • t.~~,,,~.. . • . ~ : . ' V`~ J ' • • j? .s~-, . t 'f~ ~ ' a \L" _ ~ . . - . . ~ . . ~ . . . ^ :f w U. ~ ~ • • • : ' ' ' ~ . " " ~ • c:~. ~ : i~;~?:` SIC:I~(i,'~'ilRi: ~ ~ ^ ~tti ~ . til ~ S~vof~~tA,:,~•.;;:71is~~~L~.`'~x furc mr ti~is - day of • ~ ~ s~ ~ ` r ' '~i-~-~_- tl.U. I ) ~ ~ ~ O J~...~...~. .~~.1 - ~ ; - - ~ -3 5 ' ' 'll li:~ 1t.(:2 SS ~ .~1:}t i'~;~I'?'i'~`.S T•,ItK ~'YKCUT'1' GOt1~.'i' ' ~ _ , ~ ~j'/~~ , Floric~z ~ ~ 3t'Sa By ~ . - ~t-~Cci nePut}- Cl.erl: . ~ (lu bc cccculcd ir. duphc:+(r and nriFi~..d fi1rJ ~+ilh ('1:•tk ('ircui~ ('nurl. anJ d~~pliaatr ~~itb Tax Asae»or) - d~K235 ~~E2624 . . _ ; ~