HomeMy WebLinkAbout0405 ~Declaration of Domicale and Citizenship
, .
3US123
.
TO THE CLERK OF THB CIRCUIT COURT. ~
~
ST. LUC 1 E _apvl~'1~Y~ FI,OBIDA: . ;
Tbia ts my declantioa ot Domicile aad Cilisenship In the State ot Ftorida that 1 am GUng this day in seoordsnee. u?d in
conformity with Sectioa 222.1?. Florida Statutes. ~
I was formerl a kgal resident ot ~ ' and I
tc~r~ ts"a~
resided at . However. I have changed my domicilo to
umbstl -
and a d have been a bona fide resident ot the Stete ot Florida ainoe ' day of
19 S7 . aad I reside at ¢L-
(Steeet wd Nwnber)
~ p~,~ ~ ST. LUG I E County. Florida.
_ lpe~)
aad this statemeat is to be takea as my declantion ot citizeaahip. aclual legd reaidence and domicile in the State of Fiorida.
IF FOR TNE PURPO.SE OF EkROLIING IF fOR HOMESTEAO PURPOSES~
CHILOREN IN SCNOOL~ PIEASE STI.7E ~ PLEASE CHECK2 ~
TNEtR NAMES: ~
30S~ ~
- F
FtLEO 4!tL aECQROED
ST. WCtt ..~)UMTY FLA.
F.OuE~c ~U~TRAS
. CLE3r C ~ :i1,T COURT
acrnu~~~r :;:s
AeR 3 If ii AH'75
}
~3
j I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with nU
~ othcr requirements of a legal resident of this State. .
~ I FURTHE~ G~'RTtFY that I have no intention to return to my former domicile, and I intend to remain in
ST . L U C 1 E , County,
~ (CitY) .
¢ Florida. permanen~i; .
~
~ ~ .
- " ;
. . . . i
~ - , i
g ~ ~
~ . . . : _ _ ;
~ . . . . ~
~ ~ " . . . ~ - 'a~ ~
~3 L~~~ ~
~ J~ • teaaro..? ~
;
~ da o( _-LG~%~J Cl ~ +
Sworn to and subscribed betore mc Lh~s y
~ ~ 'u-~ . A.D. l9 75 ~
~ - ~
~ ROGER POITRAS. CLERK OF CIRCUiT GOURT ~
ST. L l~ i E COUNTY, F LOR t UA
BY s
/ ~
~ ERU7Y LERK
t
' f
O R~~ ~jE ~04 Af n F'n.-m 71 22 t
BOOK
_~'b~ ' " ~ ::ik 3.?~',+c
".~^yi 3 ~ ~ ~ ~ z ~ iF~~
r.~~ ~ 1'~ Y _
"lit
. . _ _