HomeMy WebLinkAbout0161 Declaration of Domicile and Ci~~zenship ~
ro~niF c~.enK oFrie ciactnr counr.
ST. LUC I E ~EUO~:
'111s b mJr deeb~atiw? of f)omicils and Citiun~Aip in the Stat~ ol Florid~ thal I am C~lia~ tAi~ dap ie seeordanef. ~wd ln
~mitr witw Stction ~.1T~ F'iorid~ Statules.
1 wa~ to~~ a k~al ns~dent o~ 1~ ~ ~
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nsided ~t ~ N~ f•~_~ S I - HoMevet. I Aaw tua~ed mr d«aieil~ to
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ud ua and Mv~ be~a ~ bona t'id~ resid~at o( tAe Stat~ ot F'brd~ ~~ncs ~ ~=5~~ a+~? ~
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~ C • ~l~.~ and I rs~id~ at ~ ~ ~
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• ~ t L t~ [~e _ ST. lUG I E Co~aer. ~'~o~•.
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a~d tAb :tatemeat is W be takea as re?~ deelar~tioa ot titiunaAip. aetua! k~al re~idenc~ aed domieile in tht Statc o( E iorida.
If POR THE ~URPOS[ OF tNROLIIHG I~ ~OR HOMESTEAO PURIOSES~
CNII~R[N IN SCHOOI~ ?L[A.SE STAT[ ?l[AS[ CHECK: ~
TMEIR NAM[S2
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1 FL1RTIik:R Cf:RT1F'1' that 1 wdl r~p,istcr at my bca: addres~ rvAen the rcti~stratwn books rcopen, and comply with all
oll~er rcquircm~nts n( a{rgal res~dcnt of th~+ Statc.
1 FUItTI~~~ ~;F.fiTdF'Y that 1 hav~ no intcntion to return to m form~r domic,k, and 1 intcnd to rcma~n in
~ C ~ t ~ ~ ~i c~,~ . ~ T . ~ 1.~._.r - . County.
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Sworn t~ ~nd ~u:?strit~e+d bctorc mr this j• r~ d~r ol ~ L' t~ ~ ~_~_~L~ ~ 1 ~ t1 Lti~~_
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R ~R AI S Cl.E:RK 0~' C iRCU1T COUtT ) ~
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ST. I.UC 1 C tOUPJTY, F LOR 1 UA
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