HomeMy WebLinkAbout0770 . _ . . . _ ~ 7
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Q?eciaratian of Domicile ~nd Citiz~nship
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TO THE CLERK OF THE CIRGUIT COURT. ~
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ST. L11~ I E CpurrrY, Ft,o~m~: ~ ~
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This ia my decluation ot Docnicile ~nd Citizenship in the State ot Fbrida that I am Ciljng this day ia aecordance. and ia
toatormity with Section 222.17. Fiorida Statutes.
I waa [ormerl a legal resideat ot I'>~ L Fv _ G~C~ ~Y 1t/ aad I ~
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tesided at ~ e i' l~ / ~ . Ho~rever. I bave ehanged my doraicile to
(8tee~t ~nd NumbK)
and am and have been a bona fide naideat of t6e State oi Florid~ siace - day oi
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~ Dl/' ,19_L.~. and I reside at / a S's ~ T ~ i~ c_ i ` r4 lY F
(3taet ~ad Aiumber) ~
- _ ST. LUC I E County. Florids. #
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and this statement is to be taken as my declaration of citizenship. actual legal residenee and domicile in the State o[ Florida. ~
~ IF fOR THE PURPOSE OF ENROLLING IF POR HOMESTEAD PURPOSES~
CHILDREN !N SCHOOI~ PLEASE STATE PLEASE CHECK: ~
TNEiR NAMES.
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~ I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with all
' other requirements of a legal resident of this State.
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j I FURTIiE~ CERTIFY that I have ao int~ntion to return to my former domicile. and I intend to remain in
` $T . L U C 1 E , County.
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~ Florida, permanen~i~ .
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~ Sworn to and subscribed before me this ~ day ot ~
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~ . A.D.19
~ 6 ~
ROGER P01 TR ~ GIERK OF G IRCUi T COURT
~ ST. LUGIE COUNTY, FLORiUA
~ BY. .
~ E Y l E R K ~~~X~~~ ~
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