HomeMy WebLinkAbout0240 ' cl ~ r~~ion oF ~or~~ci~~ and Ci~~~~~shi
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TO THE CLEItK OF TfIE CtRCUIT COUItT, 3~~~9s
L~~ E COUNTY. FLORIDA:
• Thts Is my deela~ation ot DomicUe ~nd Citizce~hip ta the State ot Florida that I am filiag this d~,p ia aceordsnce, and in :
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conlotmity with Section 222.17. F'lorida Statuto~.
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I~ru to~mort a lega! naident ot //'-~~/l~/~ and I
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nstded ~t . Ho~revc~. I have eh~aged my domicilo to ~
i3tn~t aad Numba1 - ' ' s
and am and have been a boaa Gde reaident ot the State ot Fiorida since d~y ot
~ 19 aad I reside at • ~
l3tiwt ~ad Numeer) ~ (f- _
ST. Ll1G I E unty. Flond~.
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' and this statemeat is to be taken as my declaration ot citizen~hip. ettud kgal n~idenee and domicile in the Stato ot Florida. ~
{P F'OR THE PURPOSE OP ENROLL ING _ I F f
OR IfOMESTEAD PURPOSES~
CH'1LOREN IN SCHOOI~ PLEASE STATE PLEIISE CHECKt ~ ~
THEIR NANESS ~ .
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. . A{E CO~tltiTTAFlA. ~
ROCER'dIMAS
• C~ERK CIRCUIT COURT
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I FURTNER CERTIFY lhat I w~l register at my local addres~ when the registration books reopen. and compty with ell 2
othcr requirements ot a legal resident ot this Statc. ~ ~
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~ I F[1RT! CER that I have ao intcntion to return to my former domicile. and I intcnd to remain in
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O~ , S T. L U C I E . County.
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i Fbrids. permanen~i;. _
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! Sworn to ~nd ~ubscribed bctoro mc ihiu dny of -
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~ ~,QGER PO TRAS, GLERK OF C IRCUt T COUi2T j
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~ ST. Ll1G I E COUNTY, FLOR 1 UA ~ ;
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