HomeMy WebLinkAbout0302 Deciaration af Domicile and Citizenship
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To~ c~c oF~ cn~curroov~rr. `31~~p
^ ST. LUG i E apUN'!'~t. F[AAIDA: ~
This L m~r deelaratbn ot Doa~ieils aad Citisensbip in tbs $taLe ot Fforid~ tbat I~m tilta~ this day ip aooordanos. and fa
eoniormity arith Settioa 222.17. ~loeida Statutes.
I was focme a tesideat ot ~ N l~ //1'N~ ~ I
rl kgal .
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cesided at ~o iv i~l f~~, ~~S - However. I 6~ve eb~naed uo,p do~nicile to
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~!Ip iAd II~VO 60lD ~ b0lli ~O ~Qt Ot ~ Sbl~ O~ F~IOT~I itlflO ~f~J C~ //l / y! ~ p(
l~~-and I resIde at 9.~~//(~/i~~'P7
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tBteMt aaa I~hnebKl
~1l. .C L ~ ST. LUG I E Couat~. Ftortda.
aad this statemcnt ia to bs Lksn aa ny deelaration ot citkensbtp. utual lega! residenos ae~d domie~e in t6e 3tate oi Fbrids.
If POR THE PURPOSE OP ENROLLING Ii POR HOMESTEAD PURPOSES
CHI~OREN iN SCHOOL~ PLEASE STATE ~ P~EASE CHECK:
THEIR NAMESS
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~Q~c~ ~oi¢o~l~1A ~l/ FIlEO A~10 RECORDFO
St. LUCIE COUNTI? F~~
' ROCcR POITR~S '
~ - ClE~ii~ ~;,;CUIT COURt
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I FiJRTHER CERTIFY llu~t I will regisCer at my local address w?hen the registration booka reopea. aad ~omply ~vith atl .
other requirements oi a legal resident of this State. ~ .
I THE~ CE~~ t t I have no intention to nturn to mp lermer domieile. and I intcnd to remaia in
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' 5worn to and subscribed betore me this ~ day of L- ~
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, A.D.19 ~ ~ -
ROGER AS GLERK Of C IRCUI T COURT
~ ST. LUG 1 E C NTY F I.OR 1 UA
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~ ~BY: ~
~ ~ , EPUTY LERK ~
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~ A('A Form TI •22
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