HomeMy WebLinkAbout0772 cDeclaratior~ of f~omici~~ and Ci~iz~~shi y~
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TO TIIE CLEItK OF THE CIRCUIT COURT.
ST. LUC 1 E ~,ptJNT~t. F[,pRIDA:
Thb u my dtelaratton oi Domicile and CiE~-caship i~n the State of Florida tha! I am Gliag thia dq in tccordance. snd in
o~oatornuty writh Section 222.17. Fbrida Statutss.
I was formcrly a legal naident ot ~ ~ r~T ~ and I •
cx~r~ ~se.c~
n~ S30 Z~ ~l' L - However. I have thanged any domicile to
Isw.t aod Numbe~) ~ .
aad am and have beea a boaa Cde resident of the State ot Florida since da~ af
~elo~ er ,,.18~.andIn~ideat ~a~~ ~/O YY~f}1'Z eT.
~ • IStnst wd Numser)
I"o Q.
i % Lue ~ e ~~or ~ cl , ST. LUG I E Co,uner. ~or~aa,
ccu,~
and this statement is to be taken u my declantIoa oi eitiun~hip. actual legal n~idenee and domicile in the State ot Florida~.
If fOR THE PURPOSE Of ENROLLING IP fOR HOHES7EAa PURPOSES~ '
CHILOREN IN SCHOOL~ PLEASE STATE Pf,EASE CHECK: ~
THEIR NAMESS
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I FUR1'HER CERTIF'Y Ehat I wiil registcr at my local address when the rcgistniion books reopen. and comply wnt6 all
other reqairements of a tegal resident of this State.
~FURTNE~ CEI~TIFY .that I have no intention to return to my former domicile. and 1 intend to remain in
1' ' S~' LJCIC ST. LUC 1 E :County. ±
tac,l .
Florida. permanenti; ,
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Sworn to and subserlbcd b.~toro mo this ~ r day ot "~~~ve~'~ 8•
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1 V , A.D.19 7 ~ -
.~OGER P01 TRAS, CLERK OF C tRCl1t T COURT
-"ST. LUC i E COUNTY, F LOR t UA •
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EPUTY LERK :
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