HomeMy WebLinkAbout0484 - De~l~r~t~~r~ D~~nn~c~l~ a~d C~ixi~e~~s~~p / f
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TO T}l~: CI.ERK OF TIIE CIRCUIT COURT. ~
sT. ~ uc i e covrr~r. FLORiDA: i
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• Thi~ !a my deelaration o1 Damtri)e and Citizon~hip in the Stato ot Flotid~ that I am filing this day in accordsnco, and in i
tonto~mity w•ith Section 22.'..17. FloridR Statutea.
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I~u tormrrlY s kgal re~ident ot !'a~~~-'~~~ ~~~D 5 L/~ L G r-' ~ .1;~ f/~i L~i'~~_ ~nd I ~
lCkyl lSi~t~) ~ :
resided at l~ . Nowever. I have chaeged mr domicele to ~
(3treN aad NamE~r1 ~
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and am and hsve bcen a bona fide te~ident ot the State of Fiocida since 6~~ n ~ day of .
~ .19~ and I reatde at 7 31 ~ • ~c1~r C~/~ _ i
(Strs~t ~od Numberl ;
. ~ ..S ~ L ~ ~~3 ~ Z_ ST . LUC l E Countr. Floride, ~
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and this sta?tement is to be taken as my declaration oi citizenship. aetual legal residence and domicile in the Stat~ oi Florida. ~
If FOR THE PURP05E OF ENRO~LING Ii POR 110HESTE/10 PURPOSES
CHIIORCN tH SCH~Ot~ PtEASE STATE PLEASE CHECK;
TKE tR NIlbSES: '
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IIOGfR tdITRAS ~
~ CLf.RR ~IRCUIT COU T
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I FURTFIER CEBTIFI lhat I w il! reg-ister at my local addres~ wAen the registraVon boo4s reopea. and comply with ap
othea requiremrnu of a le~;al resident of ihu State: •
I FU~
iER CEI?TIFY thai I l:ave no intention to return to my tormer domicile, and I inlend ta remai~ in
,~bK i S j Lr~ , ST . L U C t E , County.
(Gtj) . .
Florida, pcrmanenti; .
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(Addre~.)
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Sworn to and aubscriAed Lctoro me this ~ day of o.~ i 3i Lv G1 ~ ~~S Z--.
` ~ . A.D.19.1?
ROGER P01 TF2tiS, CLERK 0~ C IRCUI 1" COI~tT .
ST. LUC I E COUNTY, FI.OR t U~1 •
E3Y :
EPUTY L£RK .
. , ~ ~ - ;~~K ~92 PACf ~ 484
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