HomeMy WebLinkAbout0735 Declaration of Domicile and Citiz~nship i ~
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321821 . '
TO THE CLEAK OF THE CIRCUIT COURT. ~
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ST. LUC I E ap~y. ~,p~p~: ~ - _
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Thts 4 av? declan~tioa o[ Domicile aad Cit~eaabip in tl~s State ot F'brida that I am Ciljag thia da,~r ia aca~cdanos. aad in
~oatamitr with Section 222.17. Fbrida Statutea.
• I was t rmer a kgal resideat ot ~•C H JY ~ T ~ T'~. ~,~i a r S, aad I
f'9~ .~~C'y~~? ~c~?~ te~.w
resided at Howaver. I!u?ve eban~ed nqr doa~icile to
t8en~t ad NurbK) `
aod am aad have beea s boas Cide resident ot the State oi ~'lorida sinca ~z ~ dq ot ~
~o !'~/wBE~ ,19~ and I rsside at ~~'/T ~OPT a ~3 ' ~`3 /~.oA~Q TEE '
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(Sttwt ~ad Numla~l LAl.
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tad thjs statement is to be takep as my deelaration ot citiunahip. artual kga! residenee and domie~k ia the Swe ot ~lorids.
If fOR THE PURPOSE Of ENROLLING Ii FOR HOMESTEAO PURPOSES~
CHIIDREN IN SCHQOI~ P~EASE STATE ?I,EASE CHECK:- ~
THEIR NAMES2
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' FICETi ~F~ '~a~.l,'ZDE~ . _
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I FURTHER CERTIFY that I will register at my local address when the registration books reopea, and comply wit6 all
other requirements of a legal resident ot this State. ~
I FURT~ CERTIFY/f~at I have no intention to return to my former domicile. u~d I intead to remain in _
p,GT f,E,ecC ST. LuciE ,~„~,ty,
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~c.ic~1 . .
Fbrida. permaneati; .
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r6Y~q aB,d1sl~~cr'bed before me this ~ day of ,~'a C% E~2 C C
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(~,i . A.D.19 -
ROGER P(21 TRAS, CLERK OF G IRGUI T COU2T
ST. LUGlE COUNTY, FLORIDA "
BY: , 1
- PUTY LERK
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AGO Form 11 ?2
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