HomeMy WebLinkAbout0162 D~ctarati~n of Domicile and Gitizenshi ~
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TO TH~ CLERK OFTHE CIRCUIT OpURT~ s
ST. LUC 1 E ~pU~y. ~,p~oA: ~
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Tbis b iny dcelaratbn o[ Domktle and Citizen~htp la tM State ot Florida tliat I am C~tas tht~ da~r in saadana. ~nd In
cbntociaaity witl~ Seetioa 222.17. ~'lorida SbtutM. j
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~ I ~rat t rl a k~al raideni ot -
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o~ G 3 1~~`s h~ u~a`~~ ~
resid~d st Ho~r~wr. I bav~ diaa
1serNt N~+ee.r) r d'~d eU? domieite w
and am and hsve beea a boaa C~de resideat olthe State a[ F'brida sincs A r` 7 7
aed I realde at ~ W N 1 1. e.
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ca,ncy. ~'to~a..
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' aad tUia statement is to be takea u my ds:eLratioa ot eitlzeeuhip. actuai kgal nsidence aad domic~e in the Stat~ ot Fbrida.
IF FOR THE PURPOSE OF ENROCIING IP i0R HOMESTEAD PURPOSES~
CHI~OREN IN SCHOOL~ P~EASE SYA7E PLEASE CHECK: ~
THE1R NAMES: ~
qrn ~s Illo~rna ~n ~u~k o ~
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~ E covNtr ~i,°,, c
~~FR~~ R ~n COURt ` 1
RECORO YERIf1E0_ '
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I FURTNER CERTIFY that I w~l register al my 1oca1 addres~ rvhea the tegistration books r+eopen. and eomply ~vith all
otbcr requirement~ o[ a legal resident ot this Stale.
I FURTHEZ CERTIFY tluet I hsve ao intention ta return to m tormer domicile. and I intend to remain in
~ l tl C 1 E County.
(C~t~l : - -
Fbrida. permaneati; .
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Sworn to and subscribed bcforn mo thi~ ------y~ day oi ~T- ~T `(/C~ l P/~~ e. ~
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. A.D. l9~ ~ ~
ROGER - i TF2NS~CLEF2K OF C 1RCU1 T COU2T
St. LUGIE COUNTY, FLORI~A • ,
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EPU Y LERK i
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