HomeMy WebLinkAbout0821 Deciaration of Domicete and Citizensnip ~-I'
413446
TO TH~ C[.F.RK OF THE C1RCUIT COURT.
ST. LUC 1 E COUNT~I~ FLORIDA:
This Is my deelara/ion oi Uomicik ~nd Citisenship in the State ot Florida that I am C~ling thi~ day ia aceord~nce. and in
eontormity w~itA Section 222.17, Florida Statutes.
I w~s (ormerl a kgal resident ot ~N~ ~l ~ ~ - - ~'a~ ~ ~ and I
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nsided q/3 ` ' K c s r~ ST~.' f . However. I have ebanged my domicile to
t8teeK aad NumMr) ~ .
and am and have been a bona Gde residcat of lhe State ot Florida sinee ~ ~ dar ot
~A ~ .191~a and I reside at 7~~ ° • ~ ~ iL ~'N'~ ~~a i ~ `
18tre~t and Nucnb~rl
Sf ,~u c.~ ST. LUG I E County. Fiorida.
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and this slatement is to De takea as my declaration of citizenship. actual legal r~esidenee and domicile in the Statc ot Florida.
IF POR THE PURPOSE OP ENROLIIN~ IF FOR HOMESTEAD PURPOSES~
CHIIOREN IN SCHOOL~ PIEASE STATE PI~ASE CHFCK: ~
THEIR NAMES:
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,/ES.~ ~ ) ~ rA~
c~t~K c~scu~T CovaT
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A~; I~I il vs AN'1$
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413446
~ I FtJRTNER CERTIFY that I will register at my local address when the registration books reopen, and comply with aU
other mq~irements ot a legal resident ot this State.
[
' I FURTHE;t CERTIF
Y that I have no intention to re~urn to my tormer domicile. ancl I iatend to rcmain in
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o~~ : S> ~l c. ~ S T L U C I E . Counly.
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~ Florida, permanenti; .
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rk Sv?orn to and subscribcd befure me this / 7 day oi ~N c•~
~~.~-~-+c~ A.Q.19. 7 8
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ROGER POI TftAS Gl E"RK OF C IRCUI T COt~2T
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k~ ST. LUGIE GOUNTY, F~ORIUA
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