HomeMy WebLinkAbout0900 Deciarat~on of Domicile and Citizenship
413501
TO TiIE CLERK OF THE C1RCU[T COURT,
ST. !UC ! E Cp~Ty. ~,pg~p:
The~ b my deelaration oi Dom~cile and Citisenship In the State ot Florld~ tb~t I am rliag thia d~y in aceordance. and in ~
t~or~formity .vith Section 2?2.17. Flo~ida Statutes.
I was lormerlr a legal resident ot _T O~F-S f~ ~/~'~'v/ ti~ and I
^~c~ey? Is~.1
res~ded at ~f ~C ~ h tI~ y S~~~ ,L~~ • . However. I Aave ebanged my domicile to
(8tre~t and Numb~rl
and am and have betn a bona Cide resideat ot Lhe State of Florida sinte ,l ~ day ot
~ .l~u ? ~ 3~ o~ /l~~~r` _
.19L_, and I reside at ~ L
(&ewt NumDer)
~ f.,1~, L~X C~ ~ ~ ST . L UC i E County. Fbrida,
~ac>>
u?d this statement is to be taken e~s my declaration of citizen~hip, actuul legal residenet and domieilc in the Statc of Florida.
If FOR tHE PURPOSE OP EHROLIING IF fOR HOMESTEAD PURPOSES~
CHILDREN IN SCHOOL~ PIEASE STATE PLEASE CHFCK: ~
TNEIR NAMES:
x S l ~~~~r~~
~ f~ G h~ H C;,~ ~r
G~ R U
1 ~ ~ ~ ~~'~g~~
~ v''~ k- ~ ~ C~ i F~~ Clf PR ClRCWT CO
--~-7--- ' ' . ' ; ~tED
- AU~ ~ ~ 212 PM'?R
4~.3~7?1
I FURTHER CERTIFY that I wi11 register at my local address when the registration books reopea. and comply with xll
other requirements of a legal resident ot this State.
I FLIRT~iE~ CF,~TIFY that I have no intrntion to return to my former domicile. and I intend to remain in
/~.~e1c e_ , ST . l.ue ~ e . County.
~c:~c~) .
Florida, permanenti; .
pG~Ty
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Sworn to and subscribed betore me this day ot
. A.D.19. 7 8
ROGER P01 AS,~ CLERK OF GIRCUIT COI~T
ST. Ll1G 1 E COUNTY, FLOR 1 UA ~
BY:
' EPUTY IERK ~
ti~~~ ~sz F~;E ssa
AGn I'~~rm ~
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