HomeMy WebLinkAbout0228 ~ D~ctaration of Domicile and Citizenship
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M~ TO Ti(E CI.ERK OR THE CIRCU[T COURT. . , ;
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' S1. LUC 1 E CpV~y~ FLORIDA:
Thia is mr declaration ot Domicila and Citizeaahip in the State ot Florida tha! t~m Gling thL~ day ~n accordanee, and In
eop(ormitr with Seetion 222.17. Florida Statutes. '
1 wa~ torm~rlY: kga! naidcnt ot (~U ~t~'~'~'°` `l ~ C ti~;JC I_ l c' f t
~ ~ r ICit~l lStat~l
resided at v ~ r - Nowevec. 2 have ch~aged mr domicite to •
(8trwt ~ud Numbe~l
and am sod h~vc been a bona Cde re~ideat ot the State oI Florida aince dsy oi
v ~ f' ~ ,._..19 / v - aad I nside at ~ ~
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r~- ST. LUC I E Count~r, Flocida,
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and tAis statemeat is to be takea aa my decLntion ot citizen3~ip. ~ctuat legal residence and domicile in the State ot Ftorida.
Ii fOR TN.E PURPOSE OF ENROlL1NG IF FOR HOMESTEAD PURPOSES~
CNILDREN IN SCHOOL~ PIEASE STATE PIEASE CHECKS :
' THEIR NAHES: ~ _
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CLE~K C~RCUIt CO
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I FURTIiER CERTIFY that I will registcr at my t.oca! :ddres~ when Lhe registration books teopcn, and ~omply with all
other requircments of a tegat resident of this State. ~
I fl]RTIIE~ CF RTIFY that 1 hsve no intrntion to return to my tormcr domicile. and I intead to rem~+in in
: 1~ ~ Lc' c ~ S7 . L U C i E . County.
• (Cit~) .
Fbrida. permancnti; . .
G~~NTYC
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(Nam~) •
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S~+•orn to an~ ~~~1?~~rih~d betore me this ~.L„_. dsy o[ U~ l~'` _
~ , . A.U.19. 7 8
ROGER POt TRAS, CI~ERK OF C IRCUI T GOU2T ~
ST. Ll1CIE COUNTY, F~OkiUA • ~
BY: . ~
EPUTV LERK ~ ~ '
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~ 60C1c 2,~eJ •PnGE 2~G~' • ~
AGO Form 71 .1. ~ ~
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