HomeMy WebLinkAbout0676 1 /
~
Declaration of Domicile and Citizenship `r
~24U4~ ~
TO THE CLEItK OF THE CIRCUIT COURT,
i
ST. LUC I E ~pUrrry. FLpRiDA: -
TAIs ls my deelaration ot Domicile and C~tiseeship in the' State ot F1ollda tbat I am filtng this day in aeeocdanee. and ia '
eoafocmity wieh Section 222.17. Florida Statutes. f
I ~raa formerl a kgal resident ot ~~L~j~'~ and I
. / lGty1 18t~t~) ;
nsided at ~ r~ ll~ ~~.~il_~,~L,,~T . However. I have changed my domicib to }
1&rMtudNuobKl ~
and am and have been a bons Cede re~ident ot tAe Stats ot Florida since L~~dl1~ dar ot
- ad ~ 1925 and I reside at b~.~~~ ~ - ~ ~ ~ ~ • ~
. t&iwt and Numbui
~rLt~E,c~ . S T. L UG 1 E Couaty. Florida.
ca~>> .
and this statcmeat is to be talce~ as m~ deeluatioa ot eitiunahip. actual kgal residea~e and domieile ia the 3tate ot Fbtida.
•IF fOR THE PURPOSE Of ENROL~ING IF FOR HOMESTEAC PURPOSES~
CHILOREN IN SCHOOL~ PLEASE STATE P~EASE tHEtKS ~ :
THEIR NANESS t
~
i
- =~u~ciE cou~Y ~u. '
ROGEIt ApITRA:
CLERK Ct~CU1T QO~~ C
RlCORp y~RIfiCO
~c 3! ! as ~t'T5
32404'7
i
I FURTHER CERTIFY that I will register at my local address when the registratioA booka reopen. and eomply with aU :
other requirements of a tegal resident of this State. ~
i
I~~E~~RTIFY that I have no intention to return to my former domicile. and I iatend to reroain in
-.c.c~4-~-c~ ST . L U C I E County, ~
(~tit~) . - . ~
Florida. permanemi; .
~
' u ~T ~ ~
~v;1•.,;';~: ~ - ~
%o':. ~
. y ~ ~ ' t
. ' Q~ C.~ ~ ~ ~
•
' • . ~ • ~ . / ~ i
~s~ ~ Y i
: • ~ ~ha ~ •
'n ~ ] ~ ~ -
~ ~ v
. ' ~ • ti
: y ~
~ -~.~Y. • ` •
' ' lNamel
Cfl.~;. ,
~ ~ (Addnad
Sworn to and subscribed be(ote me this s~_ dsy of
- . A.D.19 75 ' . ~
ROGER P01 TRAS, CLERK OF G IRCUI T GOURT
ST. Ll1G I E COUNTY, FIOR i UA ~
!
sYz , - ~ ~ ° ~ 247 676
P U T Y L E R K $OOK FACE
. ~ .
ACO F'~~rm Tl
~
~ - :
,
~ x~
n~. , .
_ . _ ;Y-a.~'~"`:. .