HomeMy WebLinkAbout0951 ' Dectaration of Domicile and ~itizenship
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TO THE CI.ERK OF THE CIRCUIT COURT. 3~6~? 1
ST. LUC 1 E ~;p~y. ~,p~pA:
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Tbb b m~ declsatloa oi DoraMik aad Citiseaship ia tM State o[ E'lo:ida tAat I am C~ioa this dar Io aeoocdaaee. sad ta ~
oantaemitr .vich Seecioa 222.17. Florida Sacutes.
I~ras t~rme~rl a kgal e~esjdent oi r N~ S{~i~J t , ~ fl2 i~ ~ A~ aad I
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eesided at ~ 8JC-. G1~ ~ i~e ~U E r~ S~t') _ Howerer. I l~ave ehsnged my domieik to
(8~t ~ed NumbKl • -
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aeid am and bav beea a Gde eat ot t6e State ot F'loeida sinee dar ot •
~¢.rcepi- ~r /~i~on~s +~'h~ re Si~~p ;N /nA+cyy A~v~ ue ~lo i~~; ~ P~~g~~~"~'r ~
d pfe ''«N .19 and I nside st'~ • 1 Q an i~ SO
~eu~~ 18teMt ~d Nae~!
~N sea 4eAC1r. , ST. lUG i E Couacr. F'~or~..
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" aad tlw a4temeat is to be tafcen ss ~r declaratioa ot citizeaship. aetual kgal residenee and don~ieile in tba 34te ot Fbrida.
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Ii POR THE PURPOSE OF ENROLLING IF POR HOMESTEAO PURPOSES~
CHILCREN IN SCHOOL~ P~EASE STATE PLEASE CHECK: ~
TNEIR NAMES:
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F1LE~ AND RECORDED ~
. Sr. WcsE COUNTr. Ft~?. ~
ROCER POITRAS
CIERK CIRCUIT COURT
RECORO YERIFIEO
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I FURTHER CEItTIFY tlut I ~n71 ngister st my locai addres~ ~rben t1?e registntion books reopen. and comply ~vitA all ~
otbe: requirements of a legat resideat ot this State. ~
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I FURTHE~ CERTIFY tlut I luve ao inteation to return to m~ former domin7e. and I int+end ta nmsia in
- , S T. L u c ~ E . County.
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Fbrida. permsaen~i; . F
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51~t1~ON ANN ('n~~.L:~ ni~X
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Sworh tio~il'qttiubscribed befon me thu day oi _'tE N SC~1 b~~~ F i o~c ~ o A g3 Y S~
~.D. ~9 ~r _
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I AS LERK OF C IRGUI~T COU2T
ST. Ll1C 1 E GOUNTY, FLOR 10A ~
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EPUTY LERK =
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. AGO Form T1~22
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