HomeMy WebLinkAbout0491 Dec~arat~on o~ Domicile and Citizenship
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TO THE CLEItK OF THE CIRCUIT COURT. ;
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` ST. LUG i E apUtv~y. FLORIDA:
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T6b u my decluatbn ot Domlclle ~nd Citisen~Aip in the St~?to ot Fborida that I ta~ Gling this dqr in ~ordsnce. ~nd in
eoot~mity witA S~ctioe 2?2.17. Flo~ida Statutea.
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I wu f rmerl a kgal tcsidcat ot / C~' ~ a ~ , L-- ru?d I
/ ~tCttyt latat~l
~aided ~t al~?
~ i L~~~!,~~ - Ho~never. I have rlunged mr domicile to
t&e~+t aad Nrsb~tl ~
aad am at~d have beea a boaa Gde resident ot the St~te ot Fbrida aiace ~ d~y ot
~ 19, aad I re~lde at y O N~ VL
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~-~,7"~ ~ ST. LUG I E Couaty, Florida,
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" tad this statement is !o bs taken a~ mY declaration oI atisenship. actual kgal reaidena and domicile ta the Stale ot Fiorida. ~
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Ii' fOR TNE PURPOSE OP ENROLLIHG Ii POR NONESTEAD PURPOSES~ f
CNICOREN iN SCHOOL~ PLEASE STATE PLEIISE CHECK2
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• ~ LEti AND ftR,noe~e~ -
lUC1E C4UMTII FIA.
ROCER P0ITRAS
~ CLERK CIRCUITCOURT
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I FURTHER CERTIFY that I w~l register at my loc~J addresa wAen the registration books reopea. aad comply with all
ottier requirements ot a legat resident ot this State. -
I FURTAEZ CERTIFY thst I hsve qo intcntion .to return to my formgr doraicite, aad I intcnd to remain ia
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Flarids.~rtpaaenti
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Sw orn to and suLseribed betore me ,this day of ~ f R~. ~ ~ 3 3~f~o
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ROGER PO! TRAS, CIERK OF C IRGUI T COtX2T
ST. LUC t E COUNTY, f I.OR 1.UA ~
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EPUYY K -
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- ' Q~~ z' V~A~ 4liV ACU Form 71 ~
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