HomeMy WebLinkAbout2732 . . . . . . ~ ~
L~~cl~r~t:a~ ~f ~3~r~icc~e ~nd C~tiz~«sf~:~~
~ru -riii: ~~~-,~T~: nr.u c~u~-r~~ ~rnx nss~:ssox, 3(N1~93
s~, Luclr: ~ c•ouh~rY,~~~oiiii~n: ~
Ttiis is nty ~Irclaration vt' Dotnicilc an~l Citi•r.rnahip in thc Statc c~f I~lorida that I ant filin~ this cla; in
arcor~lancc. and iii conformity with Scrti~~n 222.17, Hlorida Statutrs. .
i was forn~crly a lcgal n sidrnt ot~ ~ and 1
(Cily) \ (Slatc)
rrsidrd at ~~i~.~~ . Ilo~vcvcr, 1 h~vc changcd my domicilc to
(St~ert anJ Numtxt) `aG~ '
and ~ am and havr txcn a bona fidr residcnt of thc Statc or r•iori~~ sincc ~~~~C.-'Q-~~ day of
.
P-----~ , 19~~, and 1 nsid~ at
(Street an Nur,~ber)
- • St . Lucie - County, rtorida,
tc~~~-
:snd this statement is to be takrn as my dcclaratiun of citizensbip, actual legal residence and domicite in the State
of Floricla.
(I~xri hrre any prrtinrnt facl;, ~u.h as sal.• uf prupcrty ur businrss, or rclinyuishment of empluymrnt at formrr
du'nicilr, rrmo~al u( lamily lu nr~c dumicil•r_ purchax uf home, ete.)
E'~IT~RI:'G C.iI1_~RETi I*: SC~~OOL: ~ HOI~IESTEAD I:XErlPT10?::
If e~tering children in school, ~
plelse list their nar~es:
~
'
f lEOIINpp~ CQ~ ~
i~ 111C1E C011NTY ~
R06Ei1 ~0lTRAa ~
CIERk C~RCUIT QOp~t " ,
~ RFCOpD vERir~Eo
~ t~ 9 zs AM'75
' ~Z93
~ -
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3
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1 FURTH~=K CERTIFY that 1«~il! r~,_ist.r at my lo~al address whcn the registration books reopcn, and
comply ~~ith all other m~;~iren~int, of a le;~al msid~nt of thi~ State.
1 F~URTHf:R CF:RTIf=1' th;+t ! ha~•c no intcntion to rMurn to tny (ornicr domicilc, aud I intend to rctnain in
^ ST. LUCIE
~ - v~~ ~~-C~--- _ CountY,
~ 1•lorida, p~~rt:~ancntl}. ~c•'"~
~ ~ r~"~'.~~-C4~ c ~~,a~l
= ~GNATIII~
?k
~ _ ~ as_~?~r~o~~_~~~
~ s Ic~.~~rt3~r•,
;
~ S~ rn tc, :~nd ~uhsrri~~~u hrfc~n• mc tl~is ~ a__ da~• of
s~ ~
~ _ p-?-~-~- - - . n. n. i ~ ~S' ~ \ 1-~ 0~ ~~j~
~ - - - -t•ai~;; ~ c resti
~ •rt , t? P(??`~itAS, ' LF:Rti rTRCUTT CO!)t:T `~Z~( S~~
~ , I'Zori.cla
~
~ By DeUut~ C1erk
~
(T.. br c~eculcJ in du~~lu~~t~• :~nJ on.:i~i.~l f~l.•d xilh ('Ir~l: ('i~ruit ('~~url. anJ duplir:~tr w~th T•r~ A~i•_t~ot)
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