HomeMy WebLinkAbout0927 ~4cf~~~~t:c~~ of ~Qnr~~c~l~ ~s~d ~iti~~r~s~~p '
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- ST. LUCIF ('C)UN'1'1'. 1~LOR1!)A: g0
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"I'hi~ is my d~~claration cil~ Uc~micilr and Citi~cnshi~~ in thc Statc of f1c~rida tlial 1 am filing this day in
auc~r~laiia~, an~l in c~~nformity ~vith Scctian 2"_'?.17, Florida Statutcs.
t was form~ rly a lrr:il residcnt of 1`1L_ >>~-S~S1~S , Na,r~ ~`~+CS and 1
~ (Citr) (Slate)
rrsidccl ;~t l.~`:~---_~--~.~~+44 N_.. ~V~tiV Nowrvcr, 1 havc changcd my dotnicilc to
(Sltcct and Numtxr)
and am and h~tvc bccn a l~on:~ fi~lr msidcnl of thc Statc of rlorida sincc _ LS% day of
c l~ ~ D~'^c.~ ~Q.o.N
- ---~-11~ , I ai~d I residc at _l~ ~ ~~1 e
. (Sltett and Numixr)
- --~~~~~~e- = St_. Lucie _ County. Florida,
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~in(I 1I11S Sl,~irmcnt is to be tak~n as my declaration ot'citizenship, actua{ iebal residence and domicile in thc State
uf rlori~la.
(Inuri hrre any prrtiucnl f-rcU, such as salr pruprrty or Au~inrs~, or relinquishmc~it of emplu)'mcnt at fornter
domicilc, rrmo~al uf family tu nr~v dc?mirilr. purrhase of humr, ctcJ
E~:'I'ERI,+G CHTLDRE~: I!`J SCf140L; H~MCSTEAD E?C~T'IF'TI(~^1: ~ ~
If enterii~o children in school, ~ ~ !
please 1 ist ti~eir names : f
JLED ANp RECvROE ~
ROCE PA~NTr -
cIERK c:acv~T
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. RF~aR~ rfAtPIED. ~WlRT~
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; 30~40
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~ I FU}ZT11ER Cl:RT1rY il~at 1 will rc~islrr at my local addrrss when the rcgistration books reo~~cn, and
com~~l~•-~vith all other rcq!iircmcnts of a lrcal residrnt of this Statr.
~ - ' -
~ I 1-URTHF~R CI:RTIFY that 1 h.~v. no intc»tion to rcturn to my formcr domicilc, and l intcnd to rrmain in
~ 1 Si. LUCIE
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~Z____~~~c e.----- - Cbu~ity,
, I~lorida, p~~rmanrntly. (c~1''~ -
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~ ~'Sq~?ar1~ to ~tisi ~i~~ctai~trd b~~forc mc ihis _-1_! da~• oC
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~ A.U. t9__~ ~J~ S 5- `vl~'~~~0<<1.N ~,~\v C :
k ~ z ing ress :
RnG1;R POI'fRAS CIEI;1: C7KrUIT CGURT i
~ ' ~ - ~ \e,.'~~ e - , r l o r ~cl a
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~g' F
~ ~ 7cPuty Clerk , '
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(T~~ cxccutcd in duplii ~IC a~~J nncin.il f~lrJ ~+it6 ('Irr1: ['itcu~t C~~uN. anJ Supli::~lc ~vilh Ta~ AssruiK) !
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