HomeMy WebLinkAbout0136 D~c~~r~~~e~~ ~3~smrc~6~ and Ciri~~nship~~~Ei
' • ~
~
~'0 TIIE CLF:ttK OF' TtiE CIRCUIT COURT.
__ST, LUC 1 E CpUNTY, FLORIDA:
Thi~ is my decleration of Domicile and Citizca~hip in tho Stete ot Florida thst I am tiling lhis dqr fa aecordance. and tn
tontormity with S~ction 222.17~ Florid~ Statutee.
I was torn~~r~ a legal resident ot~ ~/''~~~~'f.~" ~ and t •
~j .k ~~Z ` `7) l8tat~1 -
resided ~?t ~ ~../~i~~.>~r~i.~ P However. I heve changed mr domicile to
t8tr~et aad Numb~rl -
and am and have been a bona Cde resident o[ the State oI Florida since dar ot
.
i'7 ~
_ °2 ~ 2g and I reside at ~/9'~ ~'.~"~t ~
~ ` ~ . (8tre~t and Number)
,_.l 5- 7~i J• ST. Ll1G I E County. Florida,
.
Il:u~)
and this statement is to be taken u my declaration of citizenshiP, actual Icgal rcaidenco and domicile in tbe State of Florida.
If POR THE PtiRPOSE OF ENROLtIMG IP FOR HOMES7EAD PURPOSES~
CHILDR"EN IN SCNOOI~ PlEASE S7ATE PLEASE.CHECK: ~
YNEIR MAN~S:
~
-
~ ~ ~_l.r~_~. ~ r~ DD~.._
i
~
_
U
~~j~fl a'~j; ~
p6 ~ ~ ~t~'r -
~~rt ~,~~r~~~~
aF~~~~'~?FNtE~f~r
~
. 3 ~'7`
I Ff)RTIlER CF.RTIFY that l will register at my loca! address whert the registration books reopen, and comply witA all
othcr rcquircments oi a lcgai resid~nt of this Statc.
1 FURTIIE:t CEIiTIF'Y that I havc no intrntion to rcturn to my Iormcr domicilc. and I inicnd to remai~ in
' d-' ~ P~ S T. L U C 1 E . County.
ICit~) . •
F{oriJa, pcrmane~«; . ,
~ Y
? , 'i~
- -
. ~ ~ ~H.~,~, .
~ ' t"
~ ' Q (Addrau) ~
3MtOrn to d subse~ibce} b~forn mo this ~ v dAy ot ~ G l_~~'~ O~ J
.
~ , ~ ' J
. A.D.19 76
-
~,R~ER P0,! YF~1~S~_c_l_ERK OF C IRCUI T GOUF2T .
ST. LtlCI~C COUNTY, FLORIUA • _
B,r: ~ . - .
u T ~ C ~s r' ~ ~ ,
c~:!:~.~~~ ~'.1G~ 136 ~