HomeMy WebLinkAbout1789 ~'.~L~~~r~t~~:~ afi C~~~~~~ECE~e ~r~~ L~~i~ens~:i~ .
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ST. LUCIE-- _ ('t)l!N'I'1'.1~1.c)IZ11)A:
"Il~i• is nz~~ ~Irclarati~~n of !)on:icilc :~nd ('itirrnshi~~ ii~ ihe Si;~t:: cjf t'iur;da that I am Cilin~ this d:ry in
acc~nla~~cr, :~n~l in conl~urmity will~ Srcliun "'~".17, Fluri~a Statutcs.
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rrsidccl at - --L.-~~ _-1 ±=-^'%'-G . Ho~vrver, 1 havc changrd my don~icil~ to
(Strcrt and Numt+rr) ~ i
and am and havr bc~n a i~ona fidc rrsia~nt of tlic State of I~larida since _____~s~ day ot~ ~
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::nd this ;tal~:mr~~t is tu hc takcn as ~lcclar:~tion oF citizcnship, acUial l~gal residcncc and donticile in th~ Statc !
~~f Floricia. ;
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(Insrr: hcre any rcrlinaM f~ctt, auch as sale of ptuprrty ot 4usin.ss, or trlinyuishmen! of rmploymrut at (ormer ~
du~nirilr, ramu~al n( family ~u nc~~ dumicilr. purchasr of humr. clc.) ~ :
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E:~7~CLRI,~iG CHILDrE:i I1, SCHOOL: ~1 HOMESTF.AD EXL~tPTIO~~:
If etiterir.g chi.ldren in school, ~--~1 ~
p).ease ~ist t.hei_r. »ar-~es; ~
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ST. i~C1~ ~~U??TY FU. ~
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~ 1}~URT~t1f:It CI:RTII=1' that I~vill rr_•ister at •my loc:~l a~ldrrss ~?h~n the n,~istration books reoj~eu, a:id
~ ront~~l~~ with all crih~r req!iir~mcnts c?f a I~ral r~~sidcnt of this Statc.
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~ ! I~UR~'HI:R CI:f~TIFY that 1 ha~~c nc~ int~ntion to r~turn to m~~ form~r domirilr, and 1 int.nd to rrmain in
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" ST. LUCIL
° • __/1s~-ti=,~- - - - County,
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- SIGNATURE
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S~~o~n to :uul~ul~scri~c ~1 hrfc~r. mc ~hi, ~~l _ day of
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(To bc c~rcutrd io dup:i:~lr :uid nri,:in,~l (drd ~~OI~'I~~~j ~t ('uurt. and dnplirat•• ~ciUt Tax Assecti~tt)
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