HomeMy WebLinkAbout0811 Deciaration of Domicile and ~itizenship
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TO TNE CLERK OF THE CIRCUIT COUiiT.
ST. LUG I E aouN1'St. F'I,pItiDA:
Tl~s Is my deelacation ot Domtcile and Citiseaahip in the State ot Fbrida that I un filing thls day ia aeeordaaee. and in
eonfoca~ity with Section 222.17, Florida Statutas.
I wss i rmcrl a legal nsident ot L: ~ I ~
ICW1 lStat~l . E
resided at 5a 3 fV! ~&IQ.E Fit~ ~~1 ti ~ l~ . _ Ho~rever. I have elanged m~? domicils to "
l8tr~t ~d NumMr1
aud ua aad have beea a bona Cde nsideat of the State ot Fbrida sinee ...~~~Z~ ~Y ~
~
~ .19~ and I reside at ~ ~ I ~ ~ ~LII~ D /Q ~ S ~ '
18teMt aed Numb~r) •
1~6R L ,~L? ~ E _ ST. IIIG 1 E Co„n~y. Florid:.
(at7l .
and this statement is to be takea as m~r deelustion ot eitiuaship. actual kgal resideaee ud domicile in Lhe State ot Florida.
IF POR THE PURPOSE OF ENROLLING IP POR HOMESTEAD Pt1RPOSES~
CHILOREN IN SCHOOI~ PLEASE STATE PLEASE CHECK: ~
tHE1R NAMES:
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,X~1 /E'~1~1 I~1 ~c:.frtl~.~ rLv%~ic;~ y -
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, fIIEJ Rk~. RF~Y• y~
ST. LUC~E ~OUNi~ l
-F'~fEf: ~ j.tRA'~ l,
CtEpr. f-~ ~~;,T 60~Ri
' ar~.,- y:: ~E~
8tP 30 li 4~~pll'TS
31'?'~~~,
I FUIiT~iER CERTIFY thst I will register at my local addres~ when the registration books reopen. a4d eomply with all
other requirements ot a legal resident of this State. ,
I Fl)RTHE~ CERTIFY that I have no intention to return to my tormer domicile. and I intend to remain in
}~U ~E'_ ST LO e. /t . $T . UC 1 E . County.
f ~c~e,~ .
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f Florida, permanenti~.
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Si~r~~~ ~ei+i[c(sb~se~iDcii~before me this day of
t 6
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; ~ A.D. l9
` 75_
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~ ROGER POI TF2AS, CLERK OF C iRCUI T COl~2T
~ ST. I.UG 1 E COUNTY, FLOR 1 UA
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; ~44 ~ ~~1 AGO Form TI 22
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