HomeMy WebLinkAbout1233 ~I
' n o Domicile and Citizenshi ~
Declarat~o f p
TO THE CLERK OFTHE CIRCUIT COUItT. ~O~1S
ST . L UC I E CpUNTY. FLORIDA:
This is my declaration of Domicile and Citizen~hip in the State ot Florida tluiL 1 am filing this day in accordance. and in
eonformity witA Section 222.17. Florida Statules. '
. ~ .
I was fo~ a legal nsident ot s, . ~ I
. ^ (Cit tState)
residcd at / a~~- ~ n~ ~S However. I ~ave changed my domicilc to
~su~.~.aaN~eer~ - ~
and am snd have been a bona fide resident of the State oi Florida since Q~ / day o[
~ /
~ _.19~,~ and I nside at ,1 D~ CU ~v n 4~/ O r
(8tee~t ~od Number)
~ ST . L UG 1 E County. F'lorida,
(QL~I
and lhis statement is to be takea as my declaratioa ot citizeruhip, actual legal resideaee aad domicile in the State oi Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAO PURPOSES~
CHILDREN IN SCHOOL~ PLEASE STATE ~ PLEASE CHECK: ~
TIiE IR NAMES:
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~ A~a f 1 f0 ~8 lM'75 L
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I FURT'IiER CERTIFY that I will register at my local address when the registration books reopen, and comply with aU
other requirements oi a iegal resident oi this State.
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~ I FURTHE CF.RTIFY that I l~ave no intention to return to my former domicile. and I intcnd to remain in
k y_~ rG ~ , ST . L u c i E , Couocy.
~ icn,~ .
~ Florida. permanen~i; .
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Sworn le~~nd sabscrii~-iie~"yre me this ~11~ day of t ~f
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~ • >.j: A.D.19
~ R(~..`` ~~~'I it• GIER~' UF C IRCUI 7 COIf~tT
~ ST. LUC i~~ COUNTY, FLOR 1 UA `
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~ 800K ~.em PACE 1(.J~. c~ ~
~ /S ~ rm 71
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