HomeMy WebLinkAbout0021 Deci~ration of Domicile and citiz~nsn~p N ~
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TO THE CLERK OF THE CIRCUIT COURT, 4U9].~34 . !
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ST. LUC f E _ Cot1NTY, FI.OttIDA:
This is my decl~rstion o[ Qomieile and C+lisen~hip in the State ot Fbrida lhat I aa~ Cilina this day ia aceordance. aad in
conformilr with Section 222.17. Florida Statutes.
f. s~ ~~7- ~-Nc ~ L a~f/~i and I
I ~?as tormerl a legal cesident ot r~i 1~ •
ICityl 1&aN1
. However. I have ehanged aV? domieile W
resided ae 1 ~v 5~~ ~F C L~' ist~r~.aa N~e..?
and un and have been a bona fide resident ot the Stata oi Florida ~iaee 7N day ot
.,Z 5~ uC K l ~v ~ u~ ~a T~ ~,E~c:~ ;
_.Y 1:~'y
: - i9.~-. sad I reside at 1"~" • (a~ ~,,,a Humb.r?
C, . ST . lUC I E County. Fbrida,
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aad tAis ~tatement is to be talcea u my declantion oI eitizen~hip. actual kgal re~idenee and domieile in the 3tate ot Florida.
IF fOR THE PURPOSE Of ENROLIING IF FOR HOMESTEAD PURPOSES~
CHII~REh IN SCHOOL~ PLEASE-_STATE PLEASE CHECK: ~
TNEIR NAMES: -
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FIlEO ANO RECOROEU
ST.IUCIE COllNTY fll ~
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I FURTHER CERTIFY that I will register at my local address when the regi~tntion boolc+ nope'h: and comply with all
! other requirements o[ a legai reside~t of this St,~i~. ~
~ I FURTHE~ CERTIFY that I have no intention to return to my tormer domicile. and I intend to remain in ~
~ FC 5 i L c i~ ~ ST L U C 1 E County.
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~ Florida, permanenti~ .
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Sworn to and subscribed be(ore me this Y 1~
~ A.D. 19. / S
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~ _OGER P01 T_~CLERK OF C IRCUI T COURT
~ ST. LUG I E COUNTY, f lOR 1 UA
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~ BY: ~ « ~ .
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