HomeMy WebLinkAbout0668 Q~c~~r~~~~n Q~ ~~rnici3~ ~r~d ~~~i~~r~~h~p j
~i~o -rii~: s~rn-r~. nnn courv~~Y •rnx nssi:ss~k, 3~1 '
ST. LUCTE LpUN7'Y, f~LORiI)A:
Tl~i. is my drr.laration of Uomicilc and Citircntihi~~ in !he Statc ~f ~lurida tl~at 1.im filing this day in
acconlanc~, and in conformity ~yit{~ Scction 222.1?, l~lorid. tatt~tcs.
1 was 1'onncrly a Irg~~l residcnt of _~5~~~~ and 1
~ City) (St e)
rrsidrd at ~~~l~~L Q~ . Howe~er, 1 ha~~e chanbed my domicilc to
(Slrecl anJ N~mbcr) -
and am and have ix~:n a bona fide residcnt oC the State uf rlorida since ~
~ day at~
C r ~~n
_ . , 19_14, ancl I residc at ~~1~_=~- ?l~IL
' (StrEet snd Numbc~)
St. Lucie County, rlorida,
-
(city)
.~nd ti~is statement is to be tak~~n as m~~ declaration of citizcnship, actua{ lc:~al residence and domicile in the State
uf Florida.
(Inserl herr any prrtinrnt facls, such as saM uf pro{x~ty o~ busincss, ur ~clinqu~shmcnt o[ employmcnt at former -
Jomicilc, removal of family to ne~~• danicile, purchasc uf hame, elc.)
L•'I`a'CI:RI;~G CHILDRE:3 Ii3 SCHOOL: HOMEST~AD E~EriPTIU':'i: ~
If entering children in school, ~ ~
pl.ease list their names: - ~~~,(a~~l .~(eu~ Q~
r~~
Q~t1 uP Q.U~G~~ ~ d ~p,,~ ~ v~ a/~ 4
.~ao k ~~e 5~ c~k ~ a~,c~ ~ d
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~C~x.Q Q,~ 1030/74 .
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- ~ FILEu a~_ ~Et~ROfC
ST.IUCtE ~ObMTIf fLA. ~
i FCiGE'- FviTRAS ~
c~e~~~ r::::.u+~ CC!1RT ;
~ - AECGtiD \ ~~'fE~O~ ~
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~ 1 FURTIIL'R CERTII=Y that 1 will rcristcr at my local acSdress when the registration books reopcn, and
~ romply with all otlicr requiremcnts of a Ic~al resident of this State.
~ 1~URTfif:R C:RTII=~' thai I havc no intention to rettirn to my fornicr domicile, and I intcnd to mmain in
np~ ST. LUCIE
1~~-! - C'oUttt)',
- ' (('ity)
lorici~-;v~~~~tl~tly. ~
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" 2y'~` SIGIv~:CURE
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~ Sw6r~rlt~enn~~tls~a~thcd Ucforc me this _ da~~ of
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~ - - ~.D. 1~~_
~ • • zi int; _ ress
~ R(?GCR P~~TTRAS, CJ,CRi. CiRCU;T COUFT
~ _ , Flcrida
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~ $y ~ Deputy L'l e?'k ~
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~ (To tK• c Icd in ,luphtalc anJ ~~r~girial f~lyd wilh t'Irr~ ('ircuil Courl, anJ dupli. atc ~~ilh Tax /?xscssur)
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