HomeMy WebLinkAbout0314 Dectaration of - Domiciie and Citizenship
3s~o~~
TO THB CLERK OF THE CIRCUTf COURT.
ST. lllG 1 E ~putv~t~ FLOBIDA:
• 'fhis ts a~ decfuatior ot Domicile and Citiunahip ia ths Stats oi F{orida that I am Gling tRis dar ia ~ceordance, and in
eoalocmitY ~rith Sectioa 222.17. Florida Statutea.
I wa~ tormerl a kgal resideat ot ~h~mn ~ v t, _ ~ ' aad I
tcxr~ ~Q ~s~.c.
- Hiwever. I have chang~ed mY domicile to
cesided at ~ '
8trNt NusbKl L .
and am and have been a boaa C~de reaident ot the St~te ot Fbrida since 1~'~~~
~
6 ~ C~`~~~~~-- ~7 ~
~ ,19~ and I reside at ~ ~ , l ~ ~ r, •
^ ~ 18trMt a~d Nwia~) 9
.~i e, l'C~(~ ~ , ST. LUG I~ E Couniy. Florida,
(tak7) ~
and this statement is to be taken as a?r decLratioa o~ citizen~hip, aetual legd re~idence and docnicile in the State ot Fb~ida.
If FOR THE PURPOSE OP ENROLIiNG IF FOR HOMESTEAD PURPOSESi
CHIIOREN IN SCHOOL~ PIEASE STATE PLEASE CHECK: ~
TNEIR NAMES:
~ ~RQ ~,{j (1 ~P~P.S •
FiLEO AMO RECOAp~ p
=T LUCIE CO{INTY f~A
~ CIERI(CC RC{~IIT COURt
AECOAO YERIFIEO
~ ,Jay 16 II ~ 3 ~N ~77
f _ ~~~2
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~
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j I FURTHER CEIiTIFY that I will negisier at my loc.~l addres~ whea the registratioa books nopea. aad oomply with all
~ other requinments ot a kgd resideat of t6is State.
I
~ I FtIRTHE~.~CSER1'IFY t~t I have ao intention W return to mr former domicik. and I intead W remsin in
~ f ~,~IQC_~ ~ ~Q $T . L UC ~E . Couaty.
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1 E'locids. permu?enci, .
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S~rorn to aad ~uhscn'bed betore me this a~~ day ot ~~-l ~ Q,__
lYl L A.D.19Z7 ~
~ .
ROGER POI TRAS, CLERK OF C 1RCU1 T GOURT
, ST. LUGIE COUNTY, F~ORIUA ~ i
` BY: ~ . ~~"-r~ j :
EP Y LERK
~ BOar~~ PACE ~ i
~ AGO Form 71 ?2