HomeMy WebLinkAbout2943 Deciaration of Domicile an~ Citizenshi ~
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3~4809 ~
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TO THE CLERK OF TNE CIRCUIT COURT,
ST. LUC 1 E CpUNTY, Fi,,ORIDq:
This ia my declaration of Uomlcile and Citisenship in the State ot Fbr~da that I am Ciliag this dqr ia aecordanoe. and in
eontormity rvith Section 222.17. Florida Statutea. '
I was former~ a legsl resideat oi ~ ~ I
~ct~r~ _ ~sau~
~t . Ho~?ever. I have eAanged my domicile to
(Streic ~od Num~r) ~
aud am and have been a bona f~e resident ot the State ot F'lorida since ~ n~l l~~ day ot
.19~ and I reside at ~ 1~~ ~ ~ b! r Ct ( ~ Q CX
(Sqwt ~ad Namb~t)
C~ ~ E' ~ ST . L l1G I E County. Ftorida.
(CW)
aad this statemeat is to be takea as my declarstion ot cilizenship, actual legal residence and domieile ia tha Stato of_Florida.
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If fOR THE PURPOSE OF ENROIIING IF FOR HONESTEAO PURPOSES~
CNiI.DREN IN SCHOOL~ PLEASE STATE P~EASE CHECKi ~
THEIR NAMESI
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~ ~~4809
fT~LUCI
~DOUNTr %~A.
ROCcF P)ITqAs , ? ~
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~ I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with all
; other requirements ot a legal resident of this State. ~
! I FURTNE~ CERTIFY that I have no intention to return to my former domicile. and I intend to remain in ~
; • , ST. LUC1E ,County, ~
€ ((~y1 _ `
~ Florida, permanen~i; . ~
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FT ~ (Addrss.) ~
- Sworn to end subscribed be[ore me thi~ 3~ day ot Q ~~F=~ -
ah~c~`~ A.D.19 7S ,
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ROGER P01 TRAS~ CLERK OF C IRCUI T COURT ~
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; ST. Ll1G f E COUNTY, FLOR 1 UA ~
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BY: ~.c~ t~u-c..l.c-L~ _
I
EPUTY LERK ~
~ • 800K PAGE 294~ ~
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