HomeMy WebLinkAbout2800 Qe~~~~a~E~~ of l~~r~~c~te and C~t~zens~~p ~f ~
'I~O Till: S'I'A'1'i: AVD ('UU~TY TA\ ASSI~SSOR, 3~~~
. ST. I_UC1~ - --~-OUNTY, t~LOltll)A:
71~is is my dretar.itiun of Don~icilc ai~d Citiunship in th~ Statr of I~lorida tli:~t 1 am filing this day in
accor~lancc, and in cunformily witli Scrtion 2'_2.17, Florida Statutrs.
~ c~'~~ o~vG~4 Po e i ry , PPik ~•s
1 was fornicrly lcgal rrsidcnt af - _ and 1
(City) (S~ate)
A8/~~ E S T NEid 1~A~c! i~'A/~~
resicicd at t~ _ . However, 1 have chan~;ed my domicile to
(titreet and Numbcr)
~nd am and hcrvr brcn a bana fidc residcnt of tl~c Statc of Florida since day of
AP~E'- /G ~3~ TY~-/ TE s 7~: ~a~eT sT. ~u~iE tr-
, 1913 and I nsidc al -
(Stroet and Number)
.9~p ~ /C~NT~1~'K y _ ~ ~/C` St . Luc ie _ • Cou~ity, Florida,
- (c•~~~~> -
~~nd this statement i5 Co be taken as my decl:u•ation of ritirenship, actual le~;al residrnce and domicile in the State
of ~loricla. ~
(Insrti hcre ~ny perlinrnt facts, such as salr of pruperly or husiness, or relinqui}l~m.nt of employmrnt at f~rmer
domi:ile, remu~al uf family lu nc~~~ domicilr, pur:6rse of hume, rtc.)
E?:TCt:?:~:G CHTLDicEt`: I!'d SC~lOOL: ~ ~iOMi:S'fL'AD E?:ET;PTIO'::
If e ~teri_t~g children in school, 1--~
please list their tianes:
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~ 1 FURTHL:R CERTII=Y th:it l~vill registcr at my loc.il address whrn ihe registr.ition books rro~~en, and
coin{~ly with :,11 othrr rry!~ircmcnts of a lcgal rc.i~cnt of this Statr.
~ 1 rUF.THEIt CI:R771=Y that I ha~•c no intcntinn to r~turn to my form~r domicilc, and 1 intcnd to rcmain in
~ ~~DG /«NTUe/~y i.' ~'f tD/1 T f~i~~~C- ST. LUCI~
- _ - - - -r------ - ~ cow,ty,
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