HomeMy WebLinkAbout0242 ' Declaration of Domicile and Citizenship
355986
TO THE CI.SRK OF TNE CIIiCUIT COURT.
ST. LUG i E Qp~~y~ ~,pRIDA: ~
• Thia L my decluation ot Domicile and Citisewhip in the State ot E'lo~da that I ua tilias this dq iq aeeordance. ~nd in
eoniormity with Sectio~ 222.17. Florida Statutes.
I was fo~ a tegal re~Ident o[ ~~2~~ _ f! Q. ~ I
I~t~l !&at~1
resided at ~ 330 ~ 1-tLt ~ R We • . However. I bave ebanged mr domicik to
(Stn~t aod Numb~r!
and am and have been a bona Cde naident ot tAe State of Florids since ~U/1 e daf oI
~ 19.~~ , and I reside at ~ e nQk L a~~ e_
lBteMt aad N~mEul
_ Ft• l~, e Y C~ S T. L UC 1 E ~p~y, ~~d,,
tca,~
and this statemeat u to ba takea a~ my decLratioe oI eitizen~hip, actual lega! resideaee and doQaicile in the S4te o[ Fbrida,
If i0R THE PURPOSE OF ENROIIING Ii POR HOMESTEAO PURPOSES~
CHIIpREN IN SCH00~~ P~EA_SE STATE P~EASE CHECK2 ~
THEIR NAMESS -
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I FURTHER CERTIFY that I will register at my loeal addres~ when the regi~tration booka reopen. and eomply writh all
other requirement~ ot a legal cesident ot this State.
I FURTHE. ER~i
IFY tAat I have ao iateation to retusn to my former domicile, snd I iatend to remain in
' ./`~~~erL' e ST . L UC 1 E , County.
(Cit~) _ -
Florida. permanenti; .
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Sworn to and ~ubxribed before me this --Z day of 3 3`~~1
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. A.D.19~T ~
RO P01 TRAS. CLERK OF C I RCU I T COURT
ST. LUCIE COUNTY, Fl.OR10A
e,r: ' .
EP Y IERK
BOOI~ PACE
AGO Form ll 22 ~