HomeMy WebLinkAbout0953 De~t~ra~Ean a; l~~mic~le ar~d Ci~~i~~~s~~~ ~ ~
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"TU'fl~[: S'I~ATE ANI) ('OUi~7'l' 7'AX ASSI~SSUIt, '
ST . LUC I I: . ~7.1~1
. _ - ( OUN'fY, LURIUA:
Tl~is is my drelaration of Domieilr an~l Citizcnship in the Statc of I~lorida thal 1 am filin~ this dc~y in
accorclancr, .~n~l in ronformity wilh Scrtion ~'2.17, Floricia Slatuics.
T ~ .O ~ Q~ '
I was fom~crly a Icgal resident ot = lA/Cl.[(~IL(~A~ox and 1
«~Y~ '~e t a c 2,,,, (slate) -
r~si~icJ at _ . Howcvcr, t havc changcd nty domicilc to
(Strert and Number)
.?ncl am and havc bccn a bona fidc n:sidcnt of thc Statc of rlorida sincc _le~~~ ~ day of
19_~
Y and I residc at _ t~Q~_ 1.~~~' _'_~~__.~Q~~--
(Strert and Numbct)
- ~-T_•- ~"~.`C?
rc-~-~---~~~ • -----St. _ I.uc:ie-- County, Fiarida,
(c~q•) -
~:nd this statcmrnt i~ to l~e t:~krn as my declaration of citi-r_rnship. actual lrgal nsidrne~ and ~oniicile in th~ State 4
~~f ~lorida. ~
(lour: herc any prrlintnt faclc, such ac sair uf pruperty or husiueu, or telinyuishmcnt of emplu~~mrnt al formrr
domirilc, rrmo~al uf famil~ tn urw domicilc, purch~sr of home. rti J
F.;I ~CRI"G C?~ILDR~N I~~ SCHOOL: ~lO1~STEAD E?~~~iPT70':: ~
If entering children iti school, ~
Please ~ist ~hei_r names:
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~ 1 FURTIIl:R CERTIPY that 1 ~~~ill re;~ist~r at my loca) address «~hen the rr~~istration boaks reo~~en, and
~ ron~~~ly ~vith all othcr rcqt~ir~.mcnis of a I~gal r~sidcnt of this Slate_
~ I PURTHI:R C•KTIFY that ! havc no intrntion ta return tc~ m~~ forn~cr domicilc, and l intcnd to re~t~ain in
~ Q c. ~ s Lu~ Ir
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~ I~lorida, ncrmanrntl~-. ~(c~`•~
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~vVorii,to ~ t$c~dhtud brforr mc this da~~ ot
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c"e~ress
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~ Ay i~ Dc~puty Cl erk '
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