HomeMy WebLinkAbout2386 ~2~c~~r~~i~n ~fi ~~micil~ ~nd C~$i~~n~hip .
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TO Tli~ CLkRK OF T1IE C1tiCUIT COUIiT. .
ST. LUG I E (,•pUNTy, FI,pnIDA:
This is my dcelarslion oi Domicile and Cittzcnship in the Stato ot Florida tluil I am titing tbb dqr in aeeordance. and in _
toatormily with Srctian 2~.17. Fiorida Statules. ' '
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1 was torm~rl a Icgal residcnt oi . ~,~Qd~ and I .
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residcd ~?t ~ .}iowovcr. I have cfunged my domicile to
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•nd am ~nd h~vc bcc~ a bona tide restdantof the Stato of Ftorida since ~ day ot
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~9~ and I restde at / ~ S ~ ` .
r (Stre~t and Nuatber)
~~!~J1/t i. ST. LUG 1 E Couaty, Florida,
~ad this statemenl 'u to be taken as my declaration of citizenship. acluel legal residenee snd domieile in the Stato ot Fbride.
IF fOR THE PURPOSE Of ENROLLING IP fOR HOHESYEAD PURPOSES~
CHILOREN IN SCHOOI~ PIEASE STATE PLEASE CHEC~: ~
THE1R MAMES: .
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I FUItT}IER CERTIFY tha~ I wiU register at my local sddress wl~en the registration bonks reopen, and comply with all
othcr requircmenis ot a Ic6a1 residcnt ot this Stale.
1 FURTHER CERTIFY ihat I have no inltntion to return to my fc?rmer domicile. and 1 inlend to remain in
~ • , ST L U C 1 E County.
(Citr) .
Fbrida. permancnti;.
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~ Sworn to nnJ subscriLcd l,efoto me this _ a dny of ~i"
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RnGCR POITRAS, CLERK OF C,IRCUIT COU'tT
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