HomeMy WebLinkAbout0075 Declaration of aomicife and C~tizenship
~ 41~'791 . .
TO T11E CLERK OF THE CIRCUIT COURT.
ST . L UG 1 E COUNTY. f'I.ORIDA:
Th[s is my dccla~ation ot Domicile and Citizenship in the State of Florida th~t I am fiiling this da~? ia aecordance. and in
tontormity with Sectioe 222.17. Florida Statute~. ~
~ / ~ ~ ~ed I
I wa~ formcriy a legal resident o[ ~1l~ I~~~- /4'/~ ~ •
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3~~ . However. I ht~ve eh~nged my domic~e to
cesidrd at r
lStte~t ~nd Numb~rl , ~
and am ind hAVe been a bor~i Cda resident ot the Sute ot Florida aince ~ day of
_ .19.~. and I reside at ~~a
. , lStre~t ~sd Nnmperl
ST . L UC 1 E County, Florida.
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and thu ststement is to be take4 u my declsratioa ot eitizen~hip. actual legal residenee and domicile in tho State ot Florida.
IF FOR THE PURPOSE_OF ENROLIING IF FOR HONES7EA0 PURPOSES~
CHIIDREN IN SCHOOI~ PIEASE STATE PIEASE CHFCKS ~
THEIR NAHES:
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t1~Ep ANp REQpNOEO
=T. LIiC1E C4tINTtt F~~
ROCf R POITRAS
F~K C'.'.CUIT COUR
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~ A~c 1~ 9 ss AN'18 -
41~'791
I FURTIiF.R CERTIFY that I will register at my local address whea the registration books reopen, and campty with all
other requirements of a legal resident of this State.
~ I F R7'EiE~ F Y that I have ao intrntion to return to my tormer domicile, and I intend to remain in
~~p~~ p~ , S T. L U C 1 E ~ County.
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~ Florida, permanrmi;.
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- Sworn to and subscril,ed betore me this day oi ~
~ . A.D.19. 7 ~ -
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~ ROGER PAITRAS,L CLERK OF CIRCUIT COtJF2T
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= ST. LUG I E COUNTI~, ~LOR i UA ~
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~ BY: 4~(i~ G
E UTY LERK
i~ ~ 293 FA~E 75
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~ AGl1 Form 71
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