HomeMy WebLinkAbout0122 Declaration of Domicile and Citizenship ~
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TO TtIE CI.ERK OF THE CIRCUIT COURT.
S~. LUC I E apU~y. ~,p~~:
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TAb b mp deelaration ot Domicile and Citireaship In the State ot Florida that I am Gling this ds~r ia aeeordanas, and in
ooatormity with Seetion 222.17, F'torida Statute~.
• I~ras f rmerl a kgal t~esident ot D tJ / Ofit- ~f ~ ffo D f" -.Z~S 1 ~yn D~ I i
tc~,~ re~.al
e~esided at ~~~1}~~ fT ~L S~ . Ho~revet. I havs ehaagcd my domicik to
(&n~t and NumbK)
aad am and have been a boeu fide re~ideat ot the State ot Florida siaoe ~ 6~ da,)? oi
G^ To ..h£R .19~
S- and I r~eside at 72 2 S.F- 1rt~'h ~ T£ l k ~P S 7~ /9 ? f'
. ~sw«.vaN~e.r~
f,'c~'T S1, L ~c. C1~' ST. LUCIE ~~y.~, :
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and this statement u to be Lakea as my declantion oi eitiunship. aetual kgal residenee and domieile in tbe Stato o[ Fbrida.
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If fOR THE PURPOSE OF ENROIIING IF fOR HONESTEAO PURPOSES~
CHIIOREN IN SCHOOI~ PLEASE STATE P~EASE CHECK: ~
TMEIR NAMES:
~!~tC ~ :cv~r~EO
. ST.I',:: _ :.~~JMT? FLA.
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No~+ 11 1 i 4s ~H '75
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I FUBTHER CERTIFY that I wil~ register at my local addresa when the registration books reopen. and comply with all
other requirements ot a legal resident ot this State.
j I FURTHE~ CERTIFY that I have no intxntion to return to my [ormer domicile, and I intend to remain in
! PO Q T' ST L ~l C/£' ,___ST . L U C 1 E , County,
'i ICit~l .
~ F'lorida. permanen~i; .
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{ Sworn to and subxribed before me this ~ ~ day o! _1 "6 T ~iT • L u ~ / ~ f" .3~~/f .2 ~
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i ~ - . A.D. 19 ~'J~^
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~ ROGEf4~~-~POI~RA?~S`~~G1,G,ERK OF C IRCUI T COl~2T
~ ST. .~.Ut I E~- COl}IV
'T~~_=~ LOR 1 UA - ~
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~ Bw ;-l~: L ~`I4~- a ( C c> ~ f 5 - `
~ ' ~ EPUTY LERK ~l
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~ ST':~. ~ " E~:K~~i~ FAGE' .
. 122
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