HomeMy WebLinkAbout0628 Q~c~~r~$Q~n ~am~~~~~ an~1 C~~i~~r~ship _
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TO TlIE CI.ERK OF' THE CIRCUIT COUItT. - ~33Q3~t)
ST. LUC I E ~p~tv'i~y~ FLORIDA:
Thi~ b my declsration o[ Domicile and Cltizcn~hip in the Stuto o[ I~'lorida thnt I am C~ling tAi~ day in ~ecordanco. and tn
contormity with Section 2?.2.17. Florid~ Statutea. ~ • '
1
I was tormc~l A Icg~l seaident ot ~ ~ 1 e ~ ~ ~ ~ ~ . c - ~ ~ ~ ~ ~nd I
(p~r) lSt~te)
residcd at ! ~ . llowovcr. I have changed my domicil~ to
' (&~e~t ~ud Nu:nEsr) '
and am ~nd havc bccn ~ bona fidc residcnl ot lhe Stutc of Florida sinca ~ C- day of
~ .19~ and I reside at I I~~~V1 ~+CJ. ~~11
lStreet u?d NuatDerl
Pp1(`t : L.11 G~~ . ST . l UG 1 E County. Florids,
tcx~~1
and lhis statcment is to bo teken ~s my deciscntion oi citizenship. aclual legat residenco and domicile in tho State ot Florida.
IF FOR TNE PURPOSE OF ENROLIING If FOR HOMESYEAO PURPOSE5~
CHILOREN IN SCHOOL~ PLEASE STATE PLE/1SE CHECK: ~
YHEIR NAMES:
f11E0 ~i~~n~E~ ~
s~. iu~~f c~u~Tr ~c .
. ~ecEr Fa:tA~s
GlER1~ Ct; ;~~T CClfRT
_ YFG^..~~ v~H F~ED
~ ~AR 11 IO 36 AM '16
~ ~ . 3303~0
1 FURT}IER CF.RTIFY tha~ 1~vill regi~ter at my lc~cal address w}~en the registralion booY,s reopen, and comply ~vith all
other requirements of a lcbal rcsident ot lhis State. _
I FURTI~t CI:RTI • lhat I have ua intrntion ta return to my formcr domicile, and I inlcnd to rcmain in
~[CY't L~.~ LL p . $T . L U C 1 E Counly.
(Citr) . -
E Florida. pcrmanenti;.
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