HomeMy WebLinkAbout0950 Declaration of Domicile and Citizenshi
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TO THE CLERK OF THE CIRCUIT COUAT.
ST. LUC 1 E ap~y~ ~,p~DA:
T~ts b aq? deelaracta~ ot Don~c~e and Cic~eaship in ehs Sace o[ Ftorida chst i am Glias chi. dar i~ a~oor~da~o.. and ia
eoatonaicr Micb Seccion 2?2.17. Florida Satutes. -
I was to
crl~ a kgal resident ot ~Z F r r~ r aad I
. 1Ck71 laeat~f ~
resided st .5~.~ G~ G N .L~ -Z - Ho~rever. I have ebanged mp doiaieile to
(at~we aed Nas~e) ,
aad am and luve beea a bona fids e~eaideat ot the Stste of Fbrida sinee ~~-[.t.1 r~ S~~l ~ U da~ ot
I .
19~ aad I n~ide at S.~ h~ ~ t~2c_~ .~~-2 ~
_ ~ J ~ _ ST. LUC 1 Esa~«c.eaNd..e.r~
~ Couot~. F1o~ida,
' IGt71
I- aod tRis statemeat Is to be takeo as n?r deelantion ot eitizeashtp. actual kgal cesideaoe and domieile ia the State ot Flocida. ~
:
IF FOR TNE PURPOSE OP ENROILING Ii fOR HOMESTEAO PURPOSES~
CHI~OREN IN SCHOOL~ PLEASE STATE PLEASE CHECK: ~
THEIR NAMESS
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, i
ST
~UC E COUNTY i~~.
. ROCER POItRAS
' CtEitK CIRCUIT COUAT "
RECORD YERIFIEO.~,~,~,~ _
. JAy 31~ 2 ss PFl'~7 ~
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355461 '
I FURTHER CERTIFY t~li~ I 7I?IU TlRiSLEr i~ Qlr IOCi~ iadR3! MIlCA L11E TlglSLfi~lOl1 bOOICS IlO~CD. and comply w+ith aU '
~
other requiremeats o[ a legal resideat ot this State.
I b'URTHE~ CEATIF'Y that I have no intention to return to my former domieile. aad I intead to remain in -
' , ST . L U C 1 E ~ County.
t(,u71 .
F{orids. permaaenci; . ~
.-l,` t i • y ~ •
- . . - ~ = ,1 , -
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. _ L~ INam~)
(Addr~) ,
Sworn to aad subscn'bed betore me tAis ~ dar oi U~ ~i ,c.~ ~
- _ A.D.19~7~
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AS CL RK OF C iRCUI T COl~2T
ST. LUC 1 E GoUNTY, FI.OR t oA • -
~ 8Y: - '
EPUTY LERK ~ R~1~ P~ ~j~
~ ; . BOOK ~0 a7
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ACO Form 71 22 ~
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