HomeMy WebLinkAbout0468 ~ t3ec~ara~iara o~ Domicile ar~d Citizensn~p
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TO THE CL~;RK OF TNE CIRCUIT OOUIiT~ _
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ST. L UC 1 E CpUN7'Y. FLORIDA: -
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T1~l.s b my deetar~tion ot Doantcqe and Citiun~hip ia the State ot F'lotida thal I an? Wing this dqr ia sccocdance. and in
coatocmity with _Section 222.17. Rlorida Statutea. . _
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I wa tormrrl a legal reetdcnt oi A~ U N ~V ~ ~OG[ J SI AN A ~ I
02. ~ ~ 02 ~EYH.S Sf taer~ ~s~.a~
re~ided at Howsver. I havs cluAged my domicile to
IStiwt and Numbsd . .
and aat aad hare beea ~ boeu Gde reaideat oi the State ot Florida since .~U Z~
-T dar ot
19_ I,r add I rcaide ~t O $4 c~~ U, S~
1 (Stn.t asd Ndmbor)
Vr{' , ST. LUG 1 E County. Florida.
cacyl
' u~d this statemeat ~S to be taken as n~7r deelaration ot citiun~htp, ~etual kgd residence and domia'le in the Stato oi Florida.
IP fOR TNE PURPOSE OF ENROLLING IP fOR HONESTEAO PURPOSESi
CHt~~REN !N SCHOOL~ PIEASE STATE PLEASE CHECKS ~ ;
THEIR NAMES:
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N1Y FIA. -
~ ~ ItOCER ~41TRAS
~ - ~ CLfaK CSRCUtT COUII
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Au~ 25 9 i? AM'1~ -
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I FtJR1`HEA CERTIFY lhat I wil! register at my lceal addresa when the registration books reopea. and wmply with ult
other tequirements ot a legal resident ot this Slate. ~ ~ ~
I FURTHE7 CEItTIF'Y that I have no intention to return to my tormer domit~e. and I iatend to remain in
• , ST . L u c ~ E , County,
iCit~) . .
Fbrida, permanenti,: ~
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Sworn to and sut?scril~ed betoro me this dsy ol 7 ~I` L~ C~ r ~ 3 3~( ~ v
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ROGER P4ITRAS,,,_C~ERK OF ClRGUfT COt~tT ~
Si'. LUC t E.COUNTY, F I.OR 1 UA ~ -
. BY: Q . ` . , .
EPUTY K
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` dOaK z~ ~ 4~ ACO Porm 71-22
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