HomeMy WebLinkAbout0471 ~ uect~ra~x~n ot uomiciEe ana ~~Y~z~nsn~p
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TO THE CI.ERK OF THE CIItCUIT COURT. . , •
ST. lUC 1 E ~pUNTy. ~'L,pRIDA: ~
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~ Tbb ls my declantion ot Domtcile and Citiunahip iu tbe Stato oI Florid~?1h~t I~m Wing this day tti aceotdutce, ~nd in 3
eontornait~ witA Secttoa 222.17. Florid~? Siatute~. ~ ~ '
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I wa formcri a kgat reaid~nt ol ~~f R Q i f ~ ~ m~C i o e~rt ~ I
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e~estdedat •/1 4 . No~rever. I h~ve cbanged my domic~e to `
tst»~t ud NemO~rl ~ `
uid am and have bcca a bona fide naident ot the State oi Fiorida siacs ~•g ~ ~ 9 7 7 d~y ot ~
' ZZ, ~710 /1~. S. ~ / ~ . .
. 19 aAd I reskk at
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~~~~~~I~POr. , ST, LUG kE Count . Florida ~
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" aad this st~temeat ~i to be takea as aq? deei~ratioa at ritisenahtp. actual kga! ra~~enee and domicile In the 3tato ai Florida.
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If FOR TNE PURPnSE OF ENROL~ING ~ IP i0R HOMESTEAD PURPOSES~
CHIIOR~N IN SCHOOI~ PLEASE STATE PLEASE CHECK: ~
THEIR NAMESt
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I FURTNER CER'I'IFY that I will register at my locat addnss w6en the registration booics noQen. and wmply with all
other requirements of a legal resident o[ this State. - - -
I FU2tTIiEZ CERTIFY that I have ao intention to retum W my former domicik, aad I iatcnd to rcmain i~
~ T. L l1 C 1 E ~ County.
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Fbrida, permanenti; .
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5w~orn to ~nd subscriAed betoro m lhis ~ day ot /S 7, ~ a~,i~# ` ~~~C.
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A.D.19.7~ _ j
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ROGER P01 TR S, CL~RK OF C IRGUI T COl~2T
ST. lUC 1 E COUNTY, f i.~i?~ ~3 UH ~
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