HomeMy WebLinkAbout0734 DeC~~r~tion c~~ ~a~~~ci~e ~r~d CE~~~~n~hip
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TO Ttl~ GI~F:ItK Or' T1iE CIRCUIT CUUItT, ~
ST. LUC 1 E E't.~RtDA:
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This ts my dcclaratiun o( I)onucite and Citizer~.,hip in the State o1 Floric~~ thnt I am tiling this day in aaordanco, and in
eontormity w•ith Seetiori ?.22.17. Florid~ Stalutes.
WEST SrRINGf1ELD MASS
I was to~~riY n legal resident ot Rnd I
77 " HA L E $T R E E T ICitrl fSt~te)
tesided at . However, I hsve changed my domicile to
tSt~eet and Nuinber)
~nd am and have bee~ a bona fide re~ident of the 5tate ot Ftorida since 2 OT H day ot
~~~~NQ~R 78 LOT 1~? HOLIDAY OUT AT ST. LUCIE
. ]9 - - t~nd 1 resido at
~ (Street ~nd Numbsr)
S T. L UC I E Councy, Florid.,
ICity) `
and this statement is to be taken as my declaration of eitizenship, actual legal residence a~d domicile in the Stste oi E'torida. '
If ~OR THE PURPOSE OF ENROI~~NG IF FOR NONESTEAD.PU.RPOSES~
CHIL~REN IN SCHOOI~ PIEASE S7ATE PIEASE CHECK2 ~
THEIR NAMES:
~
- ~.~~p ~t:p RECORDEO
. . ' ~ JU~~.TY. FI.A.= -
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. ~Z~4~~
- ~ ~za ~ov 2a PN 2: 2 i
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CL~r.it t.~f'~~..+' i.~JLt~•
I FU[iT'NF:R CERTIFY that I wilt register at my k?ca1 addrrss w•hen the reRutration books reropen. and comply with all
othcr requicements of a Icgal resident ot lhis Stale. .
I FURTtIF;2 CFRTI th t I havc no intrntio to return to m tormer domicile, and I intcnd to ren:ain in
_ T L U C 1 E ~ . County~
.n _
Florida, pcrmanenii; .
COUIyT~ ~
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SK~~rn to snd scitfscrih~•d t~tore me this _ dny of
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-
~t~C,ER__F~OI 7~nS,^CLE:RK OF C_I RCUI T COt~2T f
ST. lUC I E COUNTY, F l Gf21 UA j
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- CPUTr ~ERK U F ~ t
- . ~-298 7~ ~ .
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Af,p Forrn 71
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