HomeMy WebLinkAbout2813 ' Domicile and Citizenshi - ~
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TO THE CI,~RK OF THE CIRCUIT COURT.
ST . L UG i E CpUN'I'Y, FLORIDA:
This ts my declaration of Domlci{e and Citizenship in tha State of Florida that I~m Ciling thia day ia aecordance. and in ~
eontormity with Sectioa 222.1T. Fiorida Statutes. , ~
~ wss formerl a legal reaident of r~ Pi~ e r{ t" . _ and I
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resided at J~~~ t+.n~) ~ n K l~~<. . . However. I have ehanged my domicile to t
(Stn~t umbsr) `
and am and have been a bona fide resideat of the State ot Florida siaca f l' e~~u day ot i
Tu~~e ,19 57 .undlresideat 50~! ~ I ~.•-~-~bl~nkl~n 1~'~
lstre~t sod umperl
r~ ST . L UG I E CouA~y. Florida.
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and this statement is to be taken ss mY declaration ot citizenship. actusl legal re~idence and domieile in the State of Florida.
IF fOR TNE PURPOSE OF ENROLLING IF FOR HONES7EA0 PURPOSES~
CHIIOREN iN SCHOOL~ PLEASE STATE PLEASE CHECK: ~
THEIR NAMESS
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! I FURTIiER CERTIFY that I will register at my local address when the registration books reopen, and comply with aD
other requircments ot a legal resident of this State.
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t I FURT}iER CF.RTIF'Y that 1 have no iM~ntion to return to my former domicile, an3 I intend lo remain in
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~ Florida, pcrmancnti; .
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s Sworn to aud subseribed Aefore me this day of F~ g~ c c t 1~_
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: RJ /t A.D. 19 7.S
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~ ROGEfl POI_TRAS,~ GLERK_OF C IRCUI T COURT ~
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ST. Ll1C I E COJNTY, F~Of21 UA ~
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~ - sooK 237 ~~2811 ~
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~ AGn Form 7) '12 "
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