HomeMy WebLinkAbout0752 ~ Declaration ~f Domicite and Citizenship ~ ~ ~
TO ~HE CLERK OF THE CIACUIT COURT. ~~~'j8'~
ST. LUC i E apvrrr~r, ~[,oRm~: '
T'his b m~r declaratioa o[ Domicile aad Cithenship in tbs State oi Flarida thaL I am filing this da~ in aecordanee. and in
eontocmity ~rith Section 222.1?, Florida Statutes.
` ued I
I~ras fornnerl a legal ceaident ot ~ l/ ~~s/~ R~~„~ ,
It~tt11 l&atd
resided at 1~'! c'~ ~ UC~= ~ i if.'~~? Hoaever. I have c6anged my domieile to
lBtrMt ud Nos~) -
and aw and bave been a bona Gde reaident ot the State oi Florids sinee dsy ot
j~ , , ~I ~ cl s1~c R~~,~~5'~1~ t' ~.~C t'.~ ~ f
_ ~ 19 and I reside at ,n.~.~.~_T
- (8t»~t ~d Nos~t)
f~ti ..Gt Uc,G _ ST. LUG I E County. Florida. ;
I~t71 ~
and this ~tement is to be takea aa m~ declustiod oi eitiunship. aetual kgal residcnee and domieile ia the State ot I~'brids.
IF fOR THE PURPOSE OP ENROLLING If FOR HOMESTEAd PURPOSES~
CHI~OREN IN SCHOOL~ PLEASE STATE PLEASE CHECKS ~
-THEIR NAMES2 ~
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I FUATHEA CERTTFY that I will register at my local address when the ngistration books reopen. aad eomply with all ~
~ other requiremeats ot a kgsl reaideal of this State. - i
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i I FURTHE~ CERTIFY tlu~t I have ao inteation to return to my fotmer domicile. and I iutend to remsia in i
~ • $ T. L U C 1 E . Couaty. i
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~ Florida. permanenci; . ~
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~ S~+or~~Eo~n~u~stfibeli Letore me this / day ot
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~ A.D. l9 7 6.
~ ROGER P01 AS CLERK OF CIRCUIT GOURT ~
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~ ST. Ll1C I E COUNTY, F ~OR t UA
~ BY : _ C'
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? EP Y IERK
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