HomeMy WebLinkAbout0822 Declaratiora of Domicile and Citizenship y'
~ 41344'7 .
TO T11E CLERK OF T11E CIRCUIT COURT.
ST. LUC 1 E CpuNTY, FLORIDA:
This Is my decl~r~tion ot Domicile ~nd Cil'uenship in the State of Fiorida that I ~m C~li~g this day in ~ccordance. and in
tontormity witA Section 222.17. Florida Statutes. ~
~ ~ snd I
I wu tormerl a legal resident o( - ~
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resided at ~ " _ However. I have ehanged my domicile to
Isvy..e.oa Nume.rl ~a<c
and am d have been a bona Gde resident ot the State ot Florida sinee day ot
~ .19 f~ and I reside at .
~ . (3ttwt ~ed Numser)
~ ST. LUG I E County.Florida,
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and this statement is to be taken u my deelaration o[ citizenship. actual legal te~idence and domieile in the State ot Florida.
~F fOR THE PURPOSE OF ENROLLING IF FOR HONESTEAO PURPOSES~
CHILOREN IN SCHOOL~ PLEASE STATE PLEASE CH~CK:
T~1 NANESi ' ~
.
~ ~ " . S~~l{1CIE COUMTY fLA
~ ~ RaCEa PO~TR~S
?RR r!?CUIT CC
. - c~F~Es
a~~ i~ i~ u6 aH
.
41344'7
I~ 1 FURTIiER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
; other requirements ot a legal resident ot this State.
~
i 1 FU , ~ CF.RTI at I e ao intention to return lo my former domicile. and 1 intend to remain in
, , l' ~ ST . LUC 1 E ,County.
~ ICitr) .
B
~ Florida. permanen~i; . _ .
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(Name)
j~i ~ J~,Mt 1'~ ~04 /
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Sworn to and subscril?ed betore me this ~ day oE l
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~ ~
~ . A.D.19. 7 8
~ ROGER P01 TFtAS, CLERK OF C IRCU i T COl~2T
-
~ ST. LUCIE COUNTY, FL4RIUA ~
~
~ BY:
~ EPUTY LERK ig~:~r~ Q'f~
~ ~e~, PACc O~.
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