HomeMy WebLinkAbout0417 . . . . . . ~L ~ .
i~~ciGs~~t:~~ ai ~~r~:cE~~ ~r~d C~~:~~ ~:~s~cp
~i~c~'n~i~. s~~n~ri, nrvu c~un~~Y ~r,~x nssi:sso~t, ~~~'83
ST. LUCTE_ ('ouN~l'Y, ~~1.oR~uA: ~
'Tl~i~ is my dcrlaration of Uamicilr :u~d Citir.cn.hi~~ in tht Slatc of F:orida that 1 am filinF lhis clay in
accord;u~rc, ,ind in conformity ~vilh Scction 222.17, Flurida Statutrs.
I was Cormcrly a Ic~,al residcnt ol' t~-- ~
' ~ ~-11= - , --'r e _ 7_O~ J~ _ and 1
~ ~ (CitY) (Sl~te)
resi~lcd at __~i~t_t~_~C ~e~~~_._ .}lowcvcr, l h.ivc changcd my domicilc to
(5lrect and Numlxr)
and ani and havc Uc~~i bona fid~~ msident of thc Stah of f~lorida sincc day of
_ _~~~`~evn L , 19_~~/ and 1 r~:~idc at ` ~ - !'_e.Q~ r c~ ~ ~a-~-~ - -
(Strcet an~ Nuaitwr)
- c-~------ . SL Luc ie Gounty, 1=lorida,
(a~r)
ai~d thi~ statcmriit is to bc t;+kcn at my dr~l~~r,ition of citizcnsl~ip, :ti~tual legal residcncc and domi~ilc in thc State
uf }~lurida.
(Inxr! here any pet[i~ernt f~cts, +uch as s:~lr ot ptoperty or bn+incas, or reli+iyuu!uncM of emE.loymeni at fonner
domicilc, removal uf family to ncw domii iir, purcl.a.r ot humc, ctc.)
E*i'fCRI~:C C~17LDRF:.T I`: SCHOUL: ~ HOMESTEA~ E1~1~"PTIU?:: ~
If enterinb children in school, ~
please list their names:
a
fi~ti3 ~l '~~Ji~DEO
ST.:! 3ir. ::J;SNTY FL~. S ~
R:~:. : ,;t~ : ~UR? ~
CLf~t : . ^1!y" C c'
~ _'~~•ED
- F'Ee 5 9 56 AM '~.5
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f ~ 30~1~83
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I FUItTH1:K CERTIFY that 1 will rcgistcr at m~~ local adilress whcn the rcristratian books mopcn, and
comply ~vith ali other rccl!~ircment~ ~f a Iegal resident ol this Statr.
~ 1 FURTHGR CF;RTII~Y th:~t [ havc no intcaition to rrturn to m~• forn~cr domicile, and I intrnd to rcmain in
4 /
~ ~r ~ s Caunty,
~ -~f -ST. LUCIC---
~ }~lorida, p°rmancntl~~. tc~~,~
~ ) /1 - ~
~ ; ~7't.J ~`W ~~i~' / l,[.-G~`t~~ ~ _ ~."=~[!L~
s~: ••..G Y- S . TATURL ~
. ~ c, i~. •
~ ~ ;y~ pG ~ r~,~.:
s
F ha j i: - i~' `
~ `'~!4~~~ r ~ C''~' '
~ i ~ ~
= S IGiJATURr
~ 'n' <ys.s ;.~~n~.: ~~•'i
~ ~••`r :~4 `._f'
~ .4jvoi~l~'t~i~i~~~~"~"-.h~"LcT~~m n~c th:s _~day of
~ O~'a ~
~ - - • A.l). 19 _ ~ ~J
~ ~ ~.n~ :rE ss
~ RO(~ER PQITItt~S CL~~;K CSRCI)fT COtI?2?' '
~
~ ~ - _ , F3or~~!a
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~ By l~~puty Cleric ,
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~ (To be exr 1cJ in Jupli:al~ anJ uripinal (~Ird w~ll~ ('Irr1: Cirruit ('ourl. rnd du~,licate ~ri1h Taa AsKSUU)
~ BOOK ~?t~ PACE ~7
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~ s-~
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