HomeMy WebLinkAbout0052 ~eclaratian of Domiciie r~ C~ i • ~
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TO THI~: CLE~tK QF THE CIIiCUIT GOURT, ,
- ST, LUC i E G~pUNTY, F3.OAIDA:
Tbis b t»y declsration ot Domicik ~d Cithonship ia tAe State of Florida that 1 aan Citina this d~r ia aceorda;ios. ~nd in
contormity writh Section 222.17~ Florids Statutes.
I was tonRe~l s legal resident of ~~~~1~~ . LS~~ and I
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resickd al ~ -~~~L1.fd.Ll~~~ HoMever. I leave cbar~ged mp domieile to
(Screet ~sd KnmbK) ~
u~d am sud have beea a bona Gde re.Qident oE the State ot Ffarida ainee 7 b~ _ day of
%-19 . and I reseda ~t J~ 7 X. ~ ~ 41~• • .
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and this statament is to be takea ~.s my dec'antion of citisenship, artud Iegai residence aad domkila in ehe State ot F:orids.
I f FOR 7k€ ~ti~~CS€ QF ~!!!4tltt !H~- _ I P FOR HQMESTE/1D PURPOSES~
CHilDREN iN $tN80L~ F'~.~ASE ST1ttE ~LEASE CHE6K= ~
YHEIR NAMESS _
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I FURTHER CERTIFY thaL I w~l registcr at my loca! addresa whea the registntion books reopen. and eomply with al!
ot6er requirements of a legal resident of this S4te.
~ R ~~~E',I~T~ ,F Y Lbat I have ~o intxntioa io r+eiurn to my lormer domicile. ancl I intend to remain in
t~ $ T I_ U C 1 f County.
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Florida. permanen~i;.
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~ tAddresa!
Sworn ta ~nd subscr.bed be(ore me this ~ Jay of ~ ~~c.V
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%~ti."~ . A.D.19_ 7G
ROGER POI TRASj G~E~2K QF .C lRGUI T GOURT ~ ~
ST. LUG ! ~ COUISfiY,~-~ ft:.Of21 G~t . -
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