HomeMy WebLinkAbout0365 . .
' Deci~ration o~ Domicile and Citizenship ,
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• Thls b my deelarstbn of Domielle aed Citisea~Aip la the Stat~ of Fbrida tlut I am fitins this da,~ ia aeao~daaa. and in ~
coatoetnity witA Saetioa 2~.1T. Flor~da Statut~s. ' i
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t~ras t~ ~ Msal raideat ot ~y'G^~'^~ ~ I
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'S 3 ri N l.~ F o 2 k Ro1. _ Ho~rw~r. I haw ehsn~d nq? doeaia'i~ to ~
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sad an? aad hav beea a boaa C~de re~id~at ot the Stat~ o[ Florid~ siaee ~ d+U? ~
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~~.~.~..u ST . l UG 1 E Coune~. Florida.
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' and tUis statement ts to be taken as mr deeLratioa ot eit~Zea~bip. actud kgal raideaee aad domiale in tb~ 3tate oi F1o~ids.
Ii fOR THE PURP~SE Oi ENROILiNG If fOR HOMESTEAO PURPOSES~
CNi~OREN IN SCHOOI.~ PIEASE sTATE ?IEASE tMECK2 ~ ~
TMEIR NAMES:
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. fllE~ AND RECOKOEO
St• aOCEit POITRI?S~A
CLERK CIRCU ~ COURT
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; I FURTHER CER'fIE`Y that I will register st my local addre» w~hen the registration boo~ks reopea, and oompir wnth all
~ other tequirements o[ s legal resident ot this State. .
E I FURTHER C E'Y tl~t I Aave no ~ntentaon to ntnrn to my former domicik. aad I intend to remaia in t
~ i.v.~ ~ _ ST . L u c ~ e _ county.
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~ Fbcida. permanen~i~ . . •
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~ Sworn to and aubscribed bcfore me this ~ day o~ ~,t.__
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R~GER P01 TRAS, CI.ERK OF C IRCUI T__COl~2T
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- ST. LUGIE COUNTY, FIORtUA ~ ,
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• BY: f
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EPUTY ERK
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