HomeMy WebLinkAbout1309 ~tiv~.s /
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Deciaration of Domicile and Citizenship
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ST. LUG 1 E ~pUNTY. gj,p~tlDA: .
Tf~is b aqr d~elaratloo ot Domkik ~ad Cit~e~ship in tM 8tab ot Flo~tda tbat I am Bliaa this d~~? ie aec+ord~no~. u~d in
oootoraattr .v~ch sectioa 222.17. ~1orw. satuees.
I was i me a ksal tesideat o[ syo ~ k /?1Ct~ yv aad I
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reaided at d/Q~4'~`1 Mo ~ l!A'YE dl~~ Vf - Ho~rew~. I 6~w e6aaaed my do~nieik to
lat~t as~ NrobK1
aAd am aad bave beeA a boaa fide rajdent ottAs 5t~ otF7o~ida siaos ~ Y9 ~ diqr ot
. lA~ aad I reaid~ at ~ ~O ~1~1' ~t.! ~ d .
n lstewt ~ NrmDKI .
~O~C7 d--~j' ~~i G) rE _ ST . L UG 1 E Councr. F~orida.
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and this statameaL is to be taken as my daelaration ot eit~enship. aetual kgal residenee iind doa~ieils in tLs SLste oI I~'lo~ids.
Ii iOR THE PURPOSE Oi ENROLLING IF FOR HOMESTEAO PURPOSES~
CHIIDREN IN SCHOOL~ PLEASE STATE ~~EASE CHECKS
THEIR NANES: 1 ~
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I I~`URTHE~i CEItTIFY that I w~71 register at my local address ~?hen the registration books teopen. and comply w?ith•aU
~ ot6er requinmeata ot a kgal nsident ot this State.
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~ I FURT~~E~ CERTIFY that I have no intention to return to my foraeer domicile. and I intend to remaia in
$ T. L U C i E , County.
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Florida. Permanea~i; . ,
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~ Sworn to ~nd sub.xr°~ ~ ~tore me this ~ day ot ~ ~ ~ v
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f~~s''„7~'i C' Y~ _ A.D.19 7~ ~Q~,'f ~
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R0~' POl~~A~~,, Lt'L'-ERK OF C IRCUI T GOt~2T
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si`=:~s~:~~.~~co~ii~~.; FLOR ~.oa
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