HomeMy WebLinkAbout2996 . . . .
Dect~rat~an of Dt~mi~~l~ and Cct~zensh~p
7'U Tlll~. 5'fA1'1: AND CUUNTY '!'Ah ASSI.:SSOR, 3~~ -
_ST. LUCIE _ ~ _ ~-aUNTY, ~LOItIDA: ~
Tl~is is my drelar,:tion of Uomicilc and Citizcnship in thc Statc of Florida that I am Clin~ this day in
accu.~lancc, and in conforn~ity with Scction 2?2.17, Florida Statutcs.
1 was 1'ormt•~ty a le~;al r~sidcnt of , ` and 1
(~~r) (s~rte)
recided at ~ . Howevcr, 1 hav~ changed my domicile to
treet and Number)
and am and h:rvc bccn a bona fide residrnt of thc State - of rlorida sincc ~ d y of
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_ _ , 19 and 1 reside at 2~~
' _J~~ , (St~eet and Number) ?
St . Lucie _ County, Florida,
.
~c~~y~ -
and this statement is to be taken as my declaration of citizenship, actuai legal residence and domicile in the State
of Florida.
?
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domicile, temu~al of family to new dumicile, purchase of homq clc.)
ENT~RI~vG CHILDRE:d Ii1 SCHOOL: ~ HONIESTEAD EXEIIPTIO*::
If enteriiig children in school,
please list their names:
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j ( 7 e ry1=
FItED AND RECOR~ED _
ST.IUCIE COUNTY LA.
~ ROCER POITRAS
CLERK CIRCUIT COURT L~
RECORO VERIFIEO
. J~ui 34 2 ~s PM'75 -
~ ~ ~ 30n500
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~ I T'URTHER CF.RTIFY th.+t I v~iil rc}:ister at ~t~y fuc~~ aui~~i~s ivnri~ Z1lC ~C~ISZi:tliVii uc,uw~ icuj?~~i, ai~u
~ cumpl}• ~vith atl othcr requimmcnts af a lcgal rrsid~~tt of this Statc.
~ 1 t=URTHI:R C •Y that a~~ o' 'o return to my forn~er domicile, and I intenJ to remain in
~ ,
~ - - fT ~erc ~ S~. Llic~ ~ County,
I=1o ' ~~msnr ly_ ~
~
~
i ~ ~'I`7A~TURE
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~ '~~U`-~l CmG~~'~+` . - ~~-e~
~ ~ ~jc.:.•: 'c ~~J.'~r~r I~iA7~RC
~ . : ~ ~ G'':.
~'a~~'
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~ . SK~ar~~~io~n~t~~lud hcfom me ihis day of
~ ...J . , t ~:'a•r y! .
: ,;f, ~ ` ~
~ /=C ~`_',i~; + ~ ' ~ - - - l). ~ 9-- -
~ - ~l ang c ress .
~ ~:~t~GC._ .•~.~'°E+S Ct:K C i itCU7T COt1RT , Fl orida
wr±.lr ~ e
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~ B~' PC~ }r v3_(:I'~,
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~ (lo bc rtcculrJ in du~~Sic~lc anJ orip~~~ ~I fJcJ witb 1'Icrk C'ircuil Cuutl. and duplicate wilh Tas Asx•csM)
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