HomeMy WebLinkAbout0010 ~~C~c~rci~it~n Jf ~~i'Y~i~C!e~ ~~t~ ~.~~l~~~..~'i~'1t ~ ~ i
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~I U 7'l ll: .ti'l i\7'l: A~U ('UUN7'ti' '1'A\ ASS1:S 'Ult, t~~ i
ST. LUCIE ~`9
_ - (~OUN'fl", 1~ L(a tll~A:
'fl~i~ is my ~lrcl:~ratic~~~ of D~micilc and Citir.cn~hi~~ in thc Statc of Plurida tl~al ! am filing this day in
arc~~r~l:u~rc, :in~i in c~,n(ormity ~vitli Scction 232.17, Nlorida St:itut~s.
1 wac f'ormcrlv a Irgal residcnt ot'._-~~~~.--------- ,-_C1~~ _ and 1
(Cilr) (Slate) ~
r..i~icd at ~t4?.s~~i~_~Y~u~° Howcvcr, 1 havc changcd my domicilc to
(Slrcnt and Numlxr)
an~! .~m and havr txrn a bon.i ftdc rosidcnt of ~ lhc Statc ut' Flarida since _G'~LI~~l2~_ day oi~
- ~~5~ 19_ 7~ , and I rrsidc at jo
~ . - ~ (Slreet anJ NumUer) ~
~t~,~~___ St . Lucie ('otmty, Florid:~,
cu~r) - -
c:nd Ihis stat~mcnt i~ to bc taken as my dcdaration of citizenship, actual hgal residcnce and ciomicilc in the State #
of rlori~la.
(Inx~i bcra ~n>• prrUncnt fact~, such ~s salr of pruprrty or DIlSjS1l`SS, or relinquisl~ment ot emplo~•ment at (orm.r
domicil~. nrqu~al of f~mily to nr~v dumicilr, purch~se o( lu•me..'tc.)
E"1TEh1'-:G . CHi LDRE?: It1 SCHOOL: HOi~STEAD rti.ri~1'IO`~: : ~
If Piit~rznY clzildren in school, ~
plea~e list their i~ai~es:
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Rf~YERK C1~~~N~T ~ 1\ s
a~a ~Rrfifit~,,,,,,.r„~ ` .
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; 1 FUR7't11:R CI;RTIPY that 1~~~ill rrgistcr at my local addmss whcn thc re.gistr~tion baol:s reoncn, and
cvn~ply wilh all c?thrr req!iirem~ nts of :i ieral resiclrnt ot' tt~i~ State.
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1 1 FUtt7'l~i;R ('}:RTIf=Y that I havc no intcntion to rcturn to my formrr domicile, and 1 intcnd to rrmaii~ in
3 ` ST. LUCIE
~-1~1 p~~-~---- - - county,
` i~loriua, perntanently. la~~~) '
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: ~"~~=y~ ,o:.~--= - SIGiv~TtIIZL
: :ni> .~'Y ti ~ , C
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; ~~~v~,~1;;~~i ~ i~~,ilicd hcfcirr mc tlii~ day of
: f ~ .3:, ~
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_ r' ~~~4 ' _ A-I). 19'_'__~ .
_ . : - ~z ~r:~`~t%7'd ~=e ~ ' ~
~ R • K' POITREiS ,1.T ~ KCUIT COUIt~' ~ ,
~ ' ~l.o:: ida
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q _I3}~ ~ r llcPtiL-y Cle1-k
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i (To Irr c~ tr.l in du~~Iirdr . nd nripin,l fitrd ~~i1h t'Irrk ('irc,nt C~rurt. and Juplir:~le Mith lac p~cr~.r)
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