HomeMy WebLinkAbout2009 D~:cfu~~~~€~r~ af ~~rn~~~i~ ~r?d Cifizenshi
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ST. 1.UClr: . - - ('OUN7'Y. I~LOR11)A:
Thiti iti my drel:ir~lion al' Uomicilc .t~icl ('itizenshir in thc Statc of I~lorida th~t 1 am filin~; this day in
accor~la~u~, an~1 in c~~nli~rmity with Section ??2.17, Florida~Statutrs.
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I w:~s forn~rrly a lrr:il residc nt of - L/_~1~,.,~----~---- ,~1_~ ancl 1
~ ~(c~tr) (swte)
rrsid~d at ___I_I_ ,~1_~-~~_~ 1`~-,i----^_ . Howc~-cr, 1 havc changccl my domicilc to
(tilrrrt aoJ Nunibrr)
and am .inc', havc bccn a bona Gd~ resickiit of thc Statc oi~ F~lorida since day of
i?.
. , 19----., and 1 rrsidr at __L ~_Z,/1_--- -
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L 1 - - --`-1--------- • - St . Luc ie_ - County, rlorida,
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~:ncl this staten~ent is ta be taken as my deciar::tion of citi-r.enshi{~, actual Irgal residence and domicil,• in lhe State
uf }=lorid:+.
(Inxr( hr~~ auy ~rNmrn! f~cls, such as wlc ui prupert) or busmess, or ~rtinyuiJunent of empluymcnt at former
dumicilr, rrmmal ut fa~n~lr tu nrw dum~ri!c . purcL•:~a~ ~~f houtr, cta•.)
~:?7TLRIi~'.G Ct~i.I_DRE?: T?i SCHnnL: HOr~STEAD EXE:'•fPTIU^i: ~
l.L ent~~inK c1li.ldr2~i in school,
please list their n~r:es: ~
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Ir
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FIIED Ay1 KEGQRDEO
ST. LUCIE C~UN1r FLA•
qi~GE-= ~~)ITRAS
CLEPti : ~:CU~T COURT ~
pfrr~: yr_;=1~~
Ml~s 21 4 ia PM'75
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~ 1 C=URTHI:It CI;R"('ll~'~' thal I~.~ill r~~istrr .~t my loc:il aJclms. H•hen th~~ rcgistratirni Uoaks reopcn, and
F coiiyply with :ilz olhcr rrq!~ir~mcnts o( a lrral r~sic:cnt of this. Staic.
~ I FURT11}:R CI:RTlrY' that i ha~r no intcntiun to rc•turs~ to my former domicilc, anc! 1 intind to rcmain in
~
~ ST. LuCIE
~ - - - - - - COUntY,
l~funda, pcr~na~zently. cr~~`~
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. $~ti;vr}t=i _..~t~t'st~.~-i;rivcd brfor~~ me this ~l:i~~ of .
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' ' (To he ~+(ccutcd in dupli:: t.• and ~~ri,;:~~.d fdcd ~•:~Ih ~lrrl. ('~rruit Cocrl. rnJ dnpli~.~lc wilh Ta~ Asxsaot)
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