HomeMy WebLinkAbout0074 Deciaratian of Domicile and Citiienship
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TO TIiE CLERK OF THE CIRCUIT 40URT.
ST. Ll1C 1~ COVN1'Y. Fi.o~m~:
This is my dectuation of DomicUe and Citi:et~.+Aip in the State ot Florida tAat I am filing this dUr in accordanee. and in
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tontordtity ~vitA Section 222.17. Fbrida Statutes.
I was tormerl a kgal reaidedt of: ~ e~ ~r ~ aad I
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and un and have been a bona fide resident oi the State ot Florida siace 5 d~'r °t
~CilS ~~j~ ~ Yct~?i~ ~t't(~•P~
) ~i n e° _ ,19~. ~ad I reside at •
(Stn~t aad NumbK)
p? t, ~ _ ST . L UG 1 E County. Fbrida. -
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wd this statement is to be takea aa my declaration ot eitiuaship. actua! kgal reaidence and domicik in the Stale ei Fbrida.
IF fOR THE PURPOSE OF ENROLLING if fOR HOMESTEAD PURPOSES~
CHILOREN lN ~CHOOL~ PIEASE STATE PLEASE CHECKS ~
THE 1 R NAME S:
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~i 1 FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
~ other requiremenis o[ a legal resident o[ t6is State.
; I FURTNER CERTIFY that I have no int~ntion to retnrn to my [ormer domicile, and I intend to remain in
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lCit~l .
~ Florida. permsnenti;.
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PILED AN' RECOR~EO
ST. LUC1E GOUNTY flA. -
P.GCEr ~J~TRAS ~
CLEflK ~ ~CUit COURT ~ -
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:~'C'Ja_ tC/•;' . (Name)
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Sworn to an8.sybscribed before me this t day of ~f La r~'-% - -
~ ~ , O , . A.D.19
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~ ROGER P01 TRAS. CLERK OF C I_RCU 1~ COU2T
ST. LIK~ E COUNTY, FLOR 1 UA .
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epurY LERK .
~ BOOK PACE , ( 4
• AGO Form 71
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