HomeMy WebLinkAbout0753 Deciaration of Domicile and Citizenship r~ ~
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T01'HE CLERK OF THE CIRCUIT COURT.
ST. 'CUG 1 E_ Covt~rr~r. FLORIDA:
Tbt~ is my decluation ot Domicile and Citizenship In the Stnte oi Florida ihst I am filing this day in ~coordance. ~nd in
eoniormitr with Sectioa 222.1?. Florida Statutes.
I was iormerl a legal resident of N`.~~ e~p N~ y u~d I _ '
--'Y lttitrl lStstd `
resided at ~J' ~ C-~~ [ J~ U r a e{y ~--t~ . Nowever. I have changed my domicile to '
(Stn~t wd Nnmbe~)
and am and have been a bons fide rESideat oi the State oi Florida siaoe a a day of
~ ~ . _ 19~ and I reside at ~~3 ~ ~ ~ m ~ t``~ ~ ~ ~ t~ c ~ e~
~ (8tr~et aad Numeer)
~p `~j . L.u c~ e. ST . Ll1G 1 E Connt~r. Florida.
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and this statement is to be taken as my declantioa of citizen~hip. aetual kgal residente and domic~7e in the State o[ Florida.
IF FOR THE PURPOSE OF ENROLIING IP fOR HOHESTEAD PURPOSES~
CNII~REN IN SCHOOL~ PLEASE STAYE PLEASE CHECK: ~
THEIR NANESS •
1 Ame S~ v, c~~ ~.t ~
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S7 lU~~: CQ+IMTY FIA.
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; I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
i other requirements ot a legal resident ot this State.
i
~ I FUft/~ ER CERTIFY thal I have no intention to return to my former domicile, and I intend to remain in
` /~p t S''~ • 1- u C 1 ~ ~ .~i T. L U C 1 E . County.
ta~y~ .
Florida. permanenti; .
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~ •~Svi~4,r t at~a scr~'b~ before me this v day ot
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~ .,,.~"l~ ft ~ A.D.19 ~.S
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~ ROGER POITRAS CLERK OF CIRCUIT COURT
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~ ST. LUG I E COUt~TY, F~OR t UA .
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~ 8Y: ~ << r- ~ t' 'c L' ~
~ ~ ~ ~ u T L E R K BOOK PAGE 75~
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AC,(1 F'orm 71
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