HomeMy WebLinkAbout0027 Declaratian of Domicite and Citizenship
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TO THE CLERK OF THB CIRCU(T COURT, 3~8~3
ST. LUC 1 E CpUNT~t. FI,ORIDA: ~
• Thu is my declaration of Domicile ~nd Citisenehip in ths State ot Florida that I un Gliag tAis dq in ueordanee. and in
eonformitr Mith Seetioa 222.1T. Florida Statutes.
t~ris Iocmcrl a legal nsident ot ~l ! i.v~ tl !f~ _ ~1 U/Q ,r 1~Z and i
I~y~ t8tat~)
nsided tt ~ ~ „ ~ y ! ~ 't-'- . Ho~rever. I have cbaaged my domicile to
( ~od NumD~el
and ~m and have beea a bona tde resident ot the State ot Florida ~iace ~ 7~ ~P o~
~ ~ .19.?~. and I ceside at ~ ~ / / e a ~J C_- ~
(&~wt ~ad NumDKI
~ ,~,~t? :L _ ST. LUG i E County. F1orida,
ccxc~l .
and tRis statement u to be takea as my dee4ntioa ot eitiunship. actnallegal reaideaee and damicife in the State of Florida.
If FOR THE PURPOSE OF ENROLLING --Ii FOR HOMESTEA~ PURPOSES~
CNIL~REN IN SGH001.~ PLEASE STATE ~ ~ PLEASE CHECKS
THEIR NAMESL
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I FURTHER CERTIFY that I will register at mr locil sddress wAen thgngistration books reoQea, snd eompiy with al1
other requirements o[ a legal resident ot this State.
~ T~FUR'~iEZ CF.~RTIFY tlJ~t I have no intention to nturn to my former domicile. and I intend to renuin in -
r-J~ r`f~ ~3~ •G<</jr~" ST . L ut 1 E .~~Caan~,jr.
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Fiorida, permu~enti, .
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SwoM~tQltnd subycribed befoce me tAis -^2 `sr day oi /_[~l ~
A.D.1917 -
ER P01 A CLERK OF C IRCUI T GOl~2T
ST. LU~lE"COUNTY, fLORtUA ~
8Y: OOK~ P,~
uTY LERK ~4
, AGO Form 11 22