HomeMy WebLinkAbout0352 D~claration af Domic~~e ana ~~~~~G~ ~~N /
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~ ~ 4149~8'7 . . ,
TO T~IE CLBftK OF THE CIRCUIT COURT. , •
• ST LUC I E COUNTY. FiARIDA:
• This b my declar~tion ot Domkilo and Citis~nship [n the 5tate ot Fiocida tlu~t I~m filina thb d~~ in aeeordance. a~d In
tontormitr with Section 222.1T. Fbrida St~tutes. .
S~ ~1Gt r~(1 ~ S ~X'-e rl i~ snd 1
I rru ~orm~rl a lega! resideat of ,~r~ ~ )
n~7~~ r However. I have changed my domicile to
residtd at ~ ~ ~ N~~r)
day ot
and un and have been a bona Cde re~ident ot the Stste of Fiocida ~inee
/_l ~3 f'/ i'~ '
w -r~41 19ZZ. and I naide ~t ~.'y : -
tt~''~ - IStntt sad NwoEer! ,
~ ST. LUG I E County. Floridi, t
lCtyli
and this statement is to be takea ~s my decLration ot citaen+hip~ attual legal residence and domicik in the State ot Florida.
I~ fOR HOHESTE/lD PURPOSESf
IF fOR .TNE PtIRPOSE Of ENROLLINC p~EASE CHECK: ~
CHIIOREN IN SCHOOL~ PIEASE STATE
• THE 1R NANES:
fr~~ AMD RECpR0E0
=T ~fiC~E COUMtr f~~,
ROCER Pa~TR
. ^I EPK CIR~UIT C UR~
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- 4.1~98'~'
I 1 FURTIiER CERTIFY that I will register at my Ioca1 address when the registration books reopen. and comply v? itfi all
I~ other requirements ot a Iegal tesident ot this State.
f I FURT~'^~ CEltTIE'Y thfi I havy, no intention to return to my tormer domicile. and I intend to remain in
~ ST L U C 1 E •~u°~y~
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, . lCit~1 .
( Floricla. permancnti~ .
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' (Addre~d
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Sw•orn ta ~nd sub~crit?cd beforc mc this dey o[
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Q,,.~_ (r.C~-.~ ~ A.ll.19. 7 ~
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~ ROGER P01"TRAS. GLERK_OF~ ~ r COIJRT
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~ ST. LUG I E COUNTY, f ~Of~ 1 UA •
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~ LPUTY LCRK ,
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~ AGO E'orm 11 ~
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