HomeMy WebLinkAbout0170 - a~~t~r~f~~~ a~ ~ -am~~r~~: a~ti~ ~~~i~~~c:~1~~~i~ ~ '
1'0 TNE CGERK OF THE CIRCtJIT COURT, ~9999
ST. LUG I E - ~pUt~ry~ F'I,ORIDA:
'1'Aia b mr dreta~atioa oI Domlcile and Citizcnahip in the Statu ot Florida thet I am Wing this dsy ~n accordaace, and in
contormitr with Sectioa 2'~'.1T. Florida Statutes. ~
I~?as formcrl a legal reaident of ~~~tL~~ ' ~t•1 and Y
tcur~
,u ,a,,~ A~_ 0. e~e~ Q p_},, ~ o~~ , However. I have ehaag~ed my domicile W
l8tis~t asd I~tumb~rt •
ad am aad have been a bona fioe residcnt ot the State ot Florida siace ~ p C~' "~e day oI
~ 19~~.. and I teaide at b~ y ~ GZ~~ CQ L? R.~' -
(3trMt wd Numeer)
~[L~- P i Y~C_~Q ~ ST. LUC ( E County. Florida,
(CU~i
aad tlus statemeot is to be taken u my declaratioa ot atiurwhip. sctual legal residence and domicile in the Stato ot Florida.
IF iOR THE PURPOSE OF ENROLIING IF FOR HONESTEAD PURPOSES~
CHI~OREN IN SCHOOL~ P~EASE STATE P~EASE CHECK: ~
TNEIR NAMES:
51 Lt~tC~~COiJlITY FLA ,
ROCER P0ITRAS
'':-EFK .,~i-CUI~ COUN ~ ~
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I FURTHER CERTIFY that I wt'U register at m}? local addres~ wheo the registratioa books reopea, and compty with ail
~ otber requireme~q of a legal resident ot this 5tate.
S
3 I FURTHEZ CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~[.p-~ Qti~Q~~ ~ ST. LUC I E County.
(Cit~1 . .
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= F'lorid~. permanenti;.
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C+M to and subscribed bctore me tAis ~ day of °'O ~J' ~So
_ ~ A.D.19.~.., '
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= ~~bGER PO1 TR , CLERK OF C IP.CUf T COUZT
= S?. LUG i E COUNTY, F LQ~21 UA ~
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"'3 EPUTY IERK p~ I
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