HomeMy WebLinkAbout0161 Declaration of Domiciie ana c~~~~zensn~p -
4~.3~3
. -
. TO TNE CI.ERK OF THE CIRCUIT COUAT. - .
N, .
• ST L UC i E COUNTY. FLORIDA:
• TAu u my deetuatioa ot Domic~ a~d ~itlsenship ia tht State ot Fbsid~ thst I am fiW''a th~+ da~ ia sccordance. and in
contormity with Sectioa 222.17. F'lorids Ststu .
T s~t-~c !'~~1 %S ~ _ - u~d I
I ~?as torme~is a legal reaideat ot ICit 1 ~ 1~'~)
~ ~ However. I bavs ehangad my domicile to ~
nsided at 18~ ~ N~~
j 2 dar ot
and am and hsve been a bo~a fide resident oi the Stste ot Florida ~inee _
~ 7-,/~ / S. 6~
~ ~ -19 [ v- ~ 1 teside it (StcMe wd N.~sD.ri
~ 7- ~ l~ ST . LUC I E Couaty, Florids. ~
t~t .
and this stsLemeat is to be taken u mr declaratioa ot eitizenihip. actual ltgal residenes and domicile ia the State ot Ftorida.
If fOR NOMESTEA~ PURPOSES~
If fOR-THE PURPOSE OP ENROLLING p~EASE CHECK2 ~
CNIIOREN IN SCHOOL~ PIEASE STATE ~
; ~ THEIR NANESS G ~
'?Z/ i ~
sj lUC E COUNtr Fl~.
ROCER P0ITRAS
- _ Cl Er K ~~~CUIT COUR ~
c ~ c ~
~ ~ ?
A,rc 9 I 3z PM'l$
4130;z3
;
{ ' t I at11 n' cer st my local addnss when the registcstion bool~s reoPen. sad compl~ w?itb all
r I F'~JR'1'HEB CERTfF'Y tha Su
; other nquiremeets oi a legal sesident oi this State. -
p I FURT~~E~ CERTIFY that I Aave ao inteation to retnrn to my iormee domic~le. and 1 intend to reroaio i°
G $f . LUC I E County.
~ - IC~t7) .
S
~
Florida. pernsanenti; .
x -
~
~
5 '
~1 1 ~
~ ~
~P~ry f1~eNa 1
~ r,~~,: ~~.o~ - . ~
~ U
. ~ ' ~p ,
_ ~l~~~_
~ . . . oN " L L ~ l-~
;f s;~-.,,~~~,a,S:GQ. 2 ~ .5.~", yo
~ y : E~,
~ ` v~/
~ ~ ~ G ~3
. ,
- .
Sworn lo and subscribed betore me this ~ day o[
13 A.D.19_ 7 8 '
-
ROGER POITRAS CIERK OF CIRCU~T COURT
b:~ .
.
r~=~ - _
s;~ ST. LUC t E COUNTY, f I.OR 1.UA - ~
~ BY:
E P U T Y L E R K ~](1~ ~ i~,,
~ ~UL ~.(~7~r .
YY
y
~ ~
~rrlc,.~~~~, ~
_ >`7
. -
; ..r„-.t~e:,..~se'.rs. ~ ~ - ~ - - -
. _ - . - -
- n"~
_6 Y' l~° ~
,a . .
~al.( . 's'~ s~ ^~~2sc-"~~ ,
~ y,. er t-"n`: - . -
~ ~ ~ . E~-~- 1.,
-~'~~r a;~ ~
. ~ ~s ~ _ w d~
~ ~w ~ c,~
~
~ ~';t:~ at..~ ,a,A~. .:~u ..3 s~~+~^e. .
w- . -
.r^ ~