HomeMy WebLinkAbout2135 Declara~ion of Damicile and Ci:tizenship '
3ss~69
TO TNE CI.ERK OF TtiE CIItCU1T COURT.
_ ST. LUG I E apuNTY. FIAAIDA: •
TWs t~ aqr deeluation ot Domkile and Citi:enship Ia the Stats ot Fbsida that I an~ filias tbls dy in aceor~danes. ~nd in
eo~afocmity rvith Sectiou 222.17. ~'lorida Statutea.
I wu former s kgal resideat at h~-~~ ~ , • and I .
. , lAV1 l
rasided at However. I 6ave eMnged my donticib to
lSt~+~t ~d N~obKl
iDa ilq iAd ~IiVO ~!1 a bOAi Gd! fel~AL O~ LIIO StiL! Ot F{Otlf~ 3~1100 S..S -.1 d•r ~
19~ind I nside at ~Q~/ ~ (1 U D/'~~xC:E'~~1.
. ( ~sd NusbK) .
ST. LUG 1 E ~„ot~.
(av~
aad this statement Is to De takea as m,y deelar~tioa ot eitisenship. uttul iegal residenee and dondeile in the State ot F'lorida.
If FOR THE PURPOSE Oi ENRO~l1NG . If fOR HOMESTEAC PURPOSES~
CHILDREN IN SCHOOI~ PLEASE STATE P1.EASE CHECK: ~
THEIR NAMES:
.~.i "~~C?~(Y 2!~! ~ ~%~A D D _ li.~"~I-~~
i1LE0 AN~ RECORDED
ST.IUCIE COUqTY FIA.
ROCER P01TRl~S
CIERK CiRCU~T COURT
RECOR4 YE~t~f1F0
Sa 11 4 ia PN'75
_ - 316'769
1 FURTHER CERTIFY that I will register at my local sddres~ when the regi~trat~on books reopea. and eomply with aU
other requirements of a legal resident of this Statc.
I I~'U RTIF'Y that I have ao iatention to nturn to my former domieile. and I intend to remain in
~~3~~~~_~ C..~. ~ ST . L U C 1 E . County.
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E Fbrida. permanentj; _ _ ~
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's, S~rorn to and subseribecl before me this day oI
i
~ • ~ A.D.19 7~
~ ROGER OI TRAS CLERK OF C IRCUI T COURT
~ ST. LIJGIE COUNTY, FLORIUA
~
~ BY ~-y~ . ~
~ E T Y L E R K doox ~43 PA~E2135 .
AGO Farm 11 22
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