HomeMy WebLinkAbout0467 Declaratian of D~miciie and Citizenship
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TO TEIE CLERK OF Tl~E GiRCUIT COURT~ ' - T
ST. LUCIE ~
. COUNTY.I~LORIDAs •
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Tbb b my deelar~tbn ot Domictle and Cittseaship in tho Slats oI Florlda that I am Gling this dUr in ~ccocdaace. ~nd in
tontamity witb Section Z22,17, Florida Statutes. •
~I wa io~rme~ a kgal realde~t ot ~ON ' c~bi
" Lou z S T iZ~ f~- ~ I ~
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cestded at ~~`1 ~Ol~t'M ~1 ~ iJ !J Ho+vever. I have e?uagad my domicile to
l8tiwt wd Numb~r) • .
atid am ~ad have been a boaa Cde resideat oi the State o1 Florida sIncs .~,L~~ ~y o~ ~
__..19~. and I resld~ ~t - ,~`~-~:-----,,So~ r,~t H ~ S ~
L _ tsen.~.aa Ndm~err
L`Re t•" ST. LUC 1 E Counc~r. Flocida.
lCty1 ~
' aad lhis ststemeat is to t~e takea as m~r decla~atlon ot eittxenehip. actual iegsl residenee aAd domie~e in the Stato ot FloricTa.
If~ POR THE PURPOSE Oi ENROLi.ING I-F i0R HONESTEAd PURPOSES~
CHIL~REN IN SCNOOL~ PLEASE STATE PLEASE CHECKS ~
TNEIR NAMES:
, ~....~_C71r3 Z
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• ~~~~C~~~TT F~A.
~ocER Po~rR~s
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I FURTNER CERTIFY ihat I w~l register at my local address when the registration books reopen, and comply with aIl
other requiremenu ot a legal resideat of this State. -
I FURTIiEZ CF.RTIFY that ( have no intentioa to return to my~ former domicile. and I intead- to remaia in
' " _ SY . L U C 1 E . County,
(Cit~1 . .
Fbrida, permanenci~ . -
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Sworn to and subseribed betoro me this ~ dny of • i~ ~ t~ ~1 3~
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A.U.19~
ROGER P01 AS~ CIERK OF C IRCUI T COU~tT
ST. LUC t E COUNTY, ~ lOR i UA ~
: BY: . _ - .
EPUTY L[R
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~ . . ACU ~'orm 91-?2
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