HomeMy WebLinkAbout2274 DeGlaration of Domicile and Citizenship ~
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TO THE CLERK OR THE CIRCUIT OOURT,
ST. LUG 1 E ~pU~y. ~,p~p~:
This is m~r dectaration ot Do~nIcIle aad CitixaasAip ta tho Staf~ o[ ~'brida tbat I am ~ thL da,~ ta aooorrdanos. aod ln
eoatonait~? with 8ettion 222.17. Florida Statuta. ~
I rnis ta~ ~ legal cesldent ot r~~ 1~~_ _'IR.Qt.t7 Q.en.n
aod I
~ ~ n ICtyl (&~1~'-
resided at ~ l~ l 1`.~11 J~~,`,A_.~1,V? I/ ~ However.I baw
t~t~c ~ed Hrs~) . ~ ~ doaoicile to
aad am and bave been a boaa fide resideat ot tbe St~te ot F'lo~ida siaos d~r ot
l~___. ind I rastde at .
18te+~t ~d N~)
t~; ST. LUG I E CouAcr. Floeida. ~
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aad this statement Is to be taken as nqr dec4ration oi citisen~hip. a~tual legal resideuce and domieik in ths State ot Florida. ~
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If FOR THE PURPOSE Of ENROLLING Ii iOR HOMESTEAO PURPOSESi 3
CNIIDREN IN SCHOOL~ PLEASE STATE ~LEASE CHECKS ~
• THEIR NAMES:
~ . D~'7- ___,_i---~i
~'4. _
_ ~ Y~ ~ _ a7'1A~2 i~ ~ R- _
ST
Lt~C~~ CaUNTY fLA.
ROCL~ P~tTRAS -
CLE~t ~i°:JiT COt3RT
RFC':; : ;;c• • !ED
• S~ t5 3 0o PH'~5
. 316868
I FURTHER CERTIFY that I wt7! register at my bca! address when the regis~ration books reopen. and comply with all
other requirements of a kgal resident of Lhis 5iate.
I FU THE~ C R t I have no inteation to return to m tom~er domicile. and ~ I intend to rernain in
~ ~T . L U C i E~ , Couaty.
Itxt~l . • -
Florida. permanenti; .
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Sworn to a subscribed before me Lhb ~ diy of ~
~ . A.D.19
ROGER P01 TRAS, CLERK OF C IRGUt T COURT
ST. Ll1G i E COUNTY, F~OR 1D _
BYs ~
EPUTY lERK
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~~RK ~4~ PA~= 2274
• ' AGO Form 71 22
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