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HomeMy WebLinkAbout1155 Decl~ration ~f D~rr~ic;;~ ac~~ C~~ix~~s~ip ~ 'I~U Tlil: S"l~A'I'l: AKU ('UUN"1't' 'fAX ASSI.SSUIZ, s`r. LUCIr covrv~rY. i..oitii~n: 303590 "fl~is iti my ~Irclar:~tion ot~ t)omicilr and Citizri~sl~i~~ in thr Sta1c of l~lorida that I am lilii~~; this day in arcoraancc. and in conformity with Scclion 22'.17, 1~lc~rida Statutcs. 1 w~as formcrly a Ic~~al resi~lcnt of ----r?~'.~-~"leS ~C,----- S?_~' .~nd 1 • (c~~r) (s~~) r~~~ided :~t ~I~ TIC~~(~. . Ha~t-e~~er, 1 have chan~;ed my domicile to tre.•t anJ Numbcr) .ir.d am ai~d hav. brrn a hona (idc resit~rnt ot thr St:ite of 1=lori~la since ~lay of~ E-~tQ~~-- . 19. __`1.~, and 1 rr~idc at - ~G~~1]1~-~'.1.rlY'5~----- T (Strret and l~umbr~) ~ . ~te Y'cc~~ - • -----St . -_Lucie County, Florida, (ci~> ) ,:nd thiti tiatcmcnt is to bc takcn as m~• dcclar.itian of ritizcnshi{~, a~tual lcgal rrsidcncc and domicilc in thc Statc <~f rlori~la. • (Inur~ here au~ pertinent factc, wch a+ ~1~ c~f pruperty nr businrss, or relinyuishment of rm~duymeM at formrr domicil~, rrmo~al uf family to nc~v Jon~icilr, purch~ce uf homc. rtc.) ~ *:G HILDREtl I~d SCNOOL: HOMLS'~EAD EaCrff''fT0`•I: ~ ; I..1T~RI C ~ If en~ering c~~ildren in school, please list their narnes: ~ ; ~ ~ rr_ -Gf u- i - f / ~ ~ / i f ~.z.%'~:.~- ~~G~-C~ L~G-G t% ~Gc_t , c~ c < / t' / ~ / ~ ~ ~ fp~ 4 =.E~:~RDEO ? f7,LJ~~~ ?:+~SM FLA. ' RG~~~' : ~;i'11~5 ~ ~ CtEkK ~s ;UfT C4URT > +~c~~a.r yf=.~1E~ \ e . ~ I~ut tl 9 ~ AH'15 ~ ~ ~ 3p35yU ~ > ~ ~ 1 I~URT11f:.Z Ct:1Z"fIFY that I~~•ill rcristcr at my loral addres~ ~~~hrn thc rrgistration bookti rcop~n, and _ # romnll~ ~~~itl~ all vther req!iirrme~~ts oi~ a Ic~al msi~tcnt c?f this State. a 3 ~ I I~URTIII:R CI:R"TIf=Y tLat I ha~•c no intcntion to return :o niy formcr domicile, and t intcnd to rcmain in ~5 -1 ST. LLCIE ~ I ~~~e. rC~'.~ - c'ounty, - I~lor~da, pennanently, ----~c~?r) ~ ~~r,_ f . , ~ ~ ^ ' - i~ , ~ . . ~CL~1~C11~--~ " ~ ' :~~~,cU~~ - i ' .f \ . _ -;i . _ _ ~ . . - . . ~ . ~ . . - _ . . ---sZC~~A~rv~~.---------- ; . ~.,~c:-: L~ i Swatr .fo and'. ~bsctihcd brforr m~ this da~~ ~f ~ r~.-•: ; 3 ' G ~ - ~ - - ~.%e,iC-' - - - - n. il.-~--~~ C ~ ~ ~ r - . :ai. i~~ rc.5s - P.Qc;I~:R P "~R~1S, CLEItK CIKCU~fT COUR'1~ , Flo~-i~,a ~ • DP~~ttl_y ~lerl: (Tu bc Cxt•~otcd i1~ JUpLc:ilr ;~~tJ ~.ri'•m:d L•}cJ ~ciN~ l hruit l': :~nJ Jupli~alc a~r. As~rswr) 800K 237 PA~ 1154 . ~ ~ - - ~ - - _ _ . , : = ~