HomeMy WebLinkAbout0286 ~~c~ar~i;ic~~~ af ~~mic~~~ a~~ C~~tize~s~~p ~
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30t1'724
ST. LUCIE _^~~~UNTY, (~LORIUA: ~
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'17~i~ is my dcclaration of 1)omicilr an~l Cili•r.cnship in thc Statc of riorid.~ that I am lilin~; this ctay in
~
acrorJancc, a~id in confonnity with S~:rtion 22~'.17, Florida Statutcs. i
1 a-as fc~rmcriy a Irgal nsidcnt of D L~,~ O_ ~ O and I
(City) (Slate)
r~sidccl at ~_"~~LT-S_S~___~ . How~:vcr, I havc changcd my domicilc to
(Slrrel and Number) ~ ~
aiid am and ha~e bcen a bonu fide residrnt of thr Statc of l~toricla since day at~
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- , 19._ and 1 ri~ide at o~ O _~I~ ~ ~ N L~ ~ ~ • -
(Street and Numbcr)
St. Lucie
--~y: ~-c ~ „ co~,~~cy, F~~~a~,
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c.nd thi~ statement is to br taken as m~~ derlaratic~n of citirensi~ip, artua) Irgal residence and domicile in the State
of l~lorida.
(Insrri hete any perlinrnt facls, such as cale of pruperty ur husinrsc, ot rctinquishment of rmploymrnt at formrr
domicil~, nmuval uf tamily to nr~c doa~i:ilt. purchasr of home. rtc.1
r~~:~rL;~t7":i~ CHILDRE:1 I~.' SCHOOL: HOI~S'i'EAU E~tEr~PT70`:: ~ ~
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If entering childre~l in school,
please list their narnes:
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Ctf~~ t;~C~i 1~11tt
Rft•O~A YfFif1 ~~~~~~r.¦~~
; ~ ~ 12 00 PM'75 ~
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~ 1 f=UR7'IIER Cf:R7'If
Y thal 1~vill re~isfrr ~it my local acldress ~nc~n thc rcgistration books rcoren, and
~ cc~~z~~~ly with all other req!~iremrnts of a le~al resident of this Statr.
~
~ I rURTHl:R Cf;RTIf=Y ihat I ha~~c no intrntion to return to my former domicile, and 1 intrnd to mmain in
~ 1 E R_~- ST. LUCIE
~ ~ ~T~ ~ CountY,
x I~lorida, pcnnanently. (c'`>>
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F :„7$wi~tb to 3nc~ .~b9crihrd hrforc mc this d:~~~ of
~ ~,r '1 A.D. 1~ 7J
y-° .y;;~', ~ - - - • ir.~ u ress
~ ~'~~~T~tt/iS, CLF.R~C S~iCUT'f' COU}t'l' , rlori~~ ~
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~ By ~ Dc~ui:y C1erk
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~ To tic x c cd in du~•licali• anJ ~~ri; in:d fdc•J i1h Clrrk ('ircuil C~rurt. •rnJ Jn~,lKalr witl? Ta~ Assc~x~t)
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