HomeMy WebLinkAbout1062 Dectar~tion af Dornicile and Citizenship
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~i~o TI11: S7'A1'~ ANt) COUN~1~~~ •rnx nsst~.ssoit,
_ ST. LUCIC----------~'~~t1N7'Y, I~LORIf)A:
'tl~is is my dcclaration c?f Domicilc and Citizcnshi~~ in thc Statc of f'lorid~~ ihat I am filing this day in
acc~~nlancc, and in conforn~ity with SLCtion 22~.17, Fiorid~ Statutcs.
1 was 1'armcrly :t Ic~al rcsiclc~it oi' , and 1
(ritr) tate)
r~sidcd at ~-~-tK-~ . However, 1 havc changed my domicilc to
el a~d Nun er) ~ -
and am and havr becn bona fide residrnt of the State of t~lorida since _ ~ day of ~
~ , 19~ and I residc at a~_,~~~~ l.! r.E 2
(Slreel and Numbe~)
~ s~'~t/ ~3,~ ~ C N _ . St . Lucie County, f~lorida,
(c~~ )
and this st~itement is to be takeai as my deciaration of citizenshii~, actual legat rr.sidence and domicile in the State
of i~lorida.
(inser. Aere any prrtinrut facts, soch as salr of property or fiwinrs.~, or rrlinquishmenl of empioyment al furmrr
domicil~, rrmosal uf lamil f tu ne~~~ dumicile, purchase uf hume, rtc.)
ENT~RI~IG CHILDRE:v I?d SCHO(1L: NOMESTL'AD EXEriPTT_0*~i : ~
If enterin~ children in sch~ol, ~
please list their names: ~
~
. ~
~
fjt~0 A!!b RfCO '
LIICIE COU~IT1' EQ
ROC~F pp~tRAS ~ ~i
~R ~RA V f~ ~IED ~OUAt ~ ~ ~
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il ~y ~i'TS
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~ 30~,~ ~
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5 1 FIJRTHER CFRT1f=Y that t~~~il) ngister at my local address ~vhcn the registration books reo~en, and ~
~ compl~~ ~viti~ all othcr rcc,uirements of a l~ral rrsident of this State. i
~ I rUR"fHER CrRTIFY that 1 havc no intcntion to rcturn to my formcr domicile, and t intcnd to remain in ~
~
~ ---~-7~'/Va'FN _~E/~1 CI~ _ ST. LUCI~ _ Count
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~ f~loriJa, pcrn~ancntly. r~~~r~ -
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. S IGi~1ATt)RE
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SWC~tii to ;iitc~~-i~lisCribcJ beforc mc this _ L~ _ day of O. l~ . A-
~ =~y~~~-- A.1). 19__~ ?.S~ ENSFJ? ~.L~/9~/y
d i..r_ 1 l llg rE'. S S
~ ^y ~rR -
.~`R~A$ , r' ~ .T:RiC CI~;i;UTT COURT ~ , : lorida
~ / _ .3..~ ~~7
~A~ "r~ EQ ~r~~, _~J De u~ C2erk ~ .
~ Y ~ _ P Y . .
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(To be eac~i+lrJ in duphca~r anJ uriFinal Itlc~1 N•ilh ('Ierk ('irruil Contt, anJ duplicate ~vi1h Ta~ A.ueswr)
~ ~ R 236 ~1062 `
~ BOOK , .
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