HomeMy WebLinkAbout0713 Decfaration of Damicil~ and Ci~tiz~~shi ~f ~
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TQ TlIE CL£RK QF T!1£ CIRGUIT C4UAT ~s~5x ~
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ST. LUC 1 E Covtrl'~t. F[AttmA:
Thia u mr deela~ation oi Domieik snd Citiunahip in t6e Sbte ot Florida tha! I Rm C~ina this dsr i~ accordanee. and in ~
~oatamity wjtA Sectioa 222.17. F'lorida Sbtute~. #
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I wa tormerl a tcgat cesideat ot ~ ~ "-Qi' - and I . ;
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reslded a! s_ ~ ~ ~S~tt ~ ~ ~ ~l`~ ~,,~q _ However. I bave ehanged mr domie7e to ;
lSw~t ~d Nus~! . .
aAd am and have beea a baia t'ide ceatdent ot the State ot Ftorlda since no c/ 7_ I~' 7~ d,r ~ ~
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. , ~ y ,,Z_.19~ and I reside at ~ ~ ~ . S _ ~ ~ S f f ~C _ <
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ST. LUG 1 E Couoty. f7orida.
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aad thls statement is to be takea as mr declantioa ot eitiuwAip. aetud kgd residenee and domieile in the State ot Florida.
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IF' FOR THE PURPOSE Oi ENROIIING Ii' POR HONESTEAC PURPOSES~ F
CHI~OREN IN SCHOOL~ PLEASE STATE PLEASE CHECKS ~ ~
tNE1R NAMESS
a~ _ ~ . . 1 ~ - ~ ~
/ 9 r 4, L' a o~~ ~ ;
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!te r`Se ~
a ~ ~ ~~.~ci ~oii
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_~e
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G' .~o o~ , 01~ li 8~'1 A!I'1i `
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; I FqATHER CERTIFY that I.viq register at my local addrea~ ~rhen the registration books reopen. and comply with all ~
' other requiremeats ot a Iegal resideat o[ this State. '
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~ I THE,Z CEBTIFY t I have no intrntion to return to my former domieile. and I intend to remain in
' ~~['c~ , ST . L UC i E , County. tf
i ~ IL~t71 .
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~ Florida. permanenti~ . .
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~ , , ' ~~`~ya' = f
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f? - (Add,~.al f ;
~ Sworn d subsc~ibcd b~torc mc tAis dar ot e1 D~ c5• ~ ~sf, ~ P
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-~C- A.D.1976 _ .
~ ROGER P01 TRAS, CLERK OF G IRCUI T COU2T ~
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~ ST. LUCIE COUNTY, FLORt.UA •
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; BY:
~ E TY LERK k ~
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