HomeMy WebLinkAbout1306 Deci~ration of Domicite and Citizenship
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TO TH~ CI.EItK OF THE CIRCUIT COURT.
ST. LUG 1 E ~pUNTy. F[~pRtDA:
Tbb is my daclaratlon oi Domiclle and Citizen~Aip iu the State ot Florlda that I ua Gliag this da,~? ia aaordanos. aad in
eoatormttr witb Sectioa 222.17. Fbrids Statuts~. '
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I~ras formr~,r~l a kgal resideat ot ~ K i T y('~
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ICWI T (~tat.)
e+esidcd at ~L~Q ~ 1 W~~ T E R 1\V S R O R~ Hoaevor, I have ehanged my domi¢ilo to
(8tr~.t ~sd NosbKl •
and am and have beea a bona Gde nsideat ot tbe State o[ Fbridi sinee N~ ~7 ~
L Y ~ 19_..,L~. and I restde at ~ l_1 C• C A M E~--~ T D R.
l8tr«t a~d Numb.r!
~0~~ S 1• _L.U C.° 1 C _ ST. LUC I E ~p~,~a,
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u?d this statement is to be taken as my dectasation ot citisenshlp, adual kgal naidence and domit~e In tl~e State ot Florida.
IF POR THE PURPOSE OF ENROLIING IF FOR HOMESTEAO PURPOSES~
CNILOREN IN SCHOOI~ PLEASE ST11TE PLEASE CHECK:
THEIR NAMESS
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f1~ED pH~} RECOf1060
A :O11AAS
~ R~ I 1 M C~ '1~ . 1Z.~.3 ~Q~S ~~1 St. RoeE C011NTY fl~.
CIERK ~Y'tf EU COU.•-~-~""
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1 FURTHER CERTIFY that I will register at my la;al address when the registrstion books reopen. and comply witb aq
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i other requirements of a legal resident of this State.
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1 FU THE~ CERTIFY that I have no intention to return to my former domicile. snd I intend to remain in _
~~~C s T. LV C i L , ST . L u ~ ~ e , County.
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Florida. permanenti; . ~
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Sworn to ~nd subscribed beiore me thi~ ~ day of
~ . A.D.19 7S
ROGER POI TFtAS, CLERK OF G IRCUI T COURT ~
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ST. LUC COUtJTY, FLORtUA ~ e
BY: ~ <<-c~~li ~~-Z ~c,-~"~ ~ ,
EPUTY IERK
~ SDOOK f'~CE ~~7
- ACO Form 71 ?2
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