HomeMy WebLinkAbout0165 . . ~
Declaratioon o~ i~~micil~ and Ci~izenship
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T017iE CLEItK OF THE CIRCUIT COURT. ~
ST_LUC i E (~pUNTY. F'i.ORIDA:
'!'ltis !s ~tY *k*I,*,!!~ !+i L~±k~k ~t~ C~t+~~n~hig in t~ Sbts ot Fbrtda tba! I am GUng this day ia ~eeordante. ~nd in
coatormier ~Ith Section 222.17. Florida Statutes.
l was (o~ a tegal resident ot v v l v' f. ~ N<<.: X~ c v and t .
( 1 lStst~1
n~~ a~~ q~''~ . Howevec. I have changed my domicile to
t8tnrt ud Nume~d • ..r ~ ~
tad am sad have bcen a bona lide re~ident ot the State ot Florid~ sinee 7--- d~r ot
.19~ and I reside at 4~~ ~ r'' f 6 t l~
lSt~t u?d Namesrl
1=~ t= v~: _ ST. LUG I E Couaty. florida,
ccu~!
and this statement is to be Wcen aa mr deelantion of citizen~hip. aetual legal residence and domicile in ihe State o! Florida.
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IF~~-FOR-THE PURPOSE Of ENROLLING If fOR HOMESTEA~ PURPOSES~
CNII~REN IN SCHOOL~ PIEASE STATE PLEASE CHECKI ~ ~
THEIR NAMESZ
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LUCtE ~OUNTYRfLA.
ROCE"n ~~ltAAs ~
~~EFK C~: CU~? CQUBT ~
~ P,ECORC lE~~ctEQ
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~E,C I;~ II Oi I~M tb
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~ 3521~79
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I FURTHER CERTtF'Y that I will register at my loul address when the ngistration books nopen, and complr with all
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~ other requirements of a Icgal resideat o[ this Statt.
~ 1 FURTHEZ CEQ~TIFY tbat I have no intention to return to my tormer domicile. :ad I intcnd to remain in
~ ~i _ $T . L UC 1 E ~ County. ~
lC+t~l .
Florida. permsnenti;.
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'$wp~i~ i~lia~~u~strit~cd tctore me this ~ day o[ ~-/~t~?c ~ t~ / o v ~ ~ c. ~~yS V
~ . 1 C ~ A.D.19 7G -
.,Q~GER P01 TRAS, CLERK OF C IRGUI T COl~2T
"'ST. LUC I E COUNTY, FLOi21.UA •
BY:
~ E TY LERK
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