HomeMy WebLinkAbout0527 , ~~ctaratian of Domicile and Citizensn~p ,
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. TO TEiE C4BftK OR THE CIRCUIT COURT. 4~~2 ~ . ~
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sT. ~uc i e couNr,r; FLQRIDA:
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Thla b mr declasatioe ot Domicue and Citisen~hiQ in tbe State ot Florida tt?at I ua C~liag this day i~ sseord~?nee, and ia
toa~ormity wtth Settion 222.17, Flotidt ~tatutas.
I was iormr~l a kg~! n~ident of ~ e T~~2 l~'. aad i
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resided st ~ S 7 - However. t bave t1u?nged mr daraieile io -
18trNt u?d Nuaab~t)
and un and have been a bona Cide te~ident of the State o! F'lorid~ since a Q day ot ;
- ---19..~~ and I reside st ~ ~ 7 - /v • ~ ~ `'fi ~
(Stn~t and NumAe~)
-~-v Y; ,P ,Q F, f, _ ST . LUG 1 E Couoc~. F~orid..
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and this staGemeat is to be taken u my declsration ot eitizen'ship. aetu~t legal r~sideace and domicile in tbe State of F'lorida.
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If fOR THE PURPOSE Of ENROLLING IF FOR HOMESTEAD PURPOSES~
CHIIDREN IH SCNOOL~ PIEASE STATE PLEASE CHECK: ~
' " TNEIR NAMES2
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IE~C9~{IN'~Y f
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- ROCER P01TR~
. ^IEaR Ci~CUIT C ~4T
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- . . A~~ ze i~ ~ S ay ~7~ • :
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I FIJRTIiER CERTIFY that I wi11 reKistcr at my local addres+ when the registration books reopen, aad complr with all
other requircments of a tegal resident ot this State.
I FURTlIE:t CBRTIFY thst I ~avc no intrntion to return to my former domicilc, and I intend to remnin in
•Fc t ~e F ~P , _ ST . L UC I E _ County, .
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Fbrida. pcrmancnti; .
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f ~~U!~jY.f~~ (Name) ~
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SM orn to ~nd subscrihcd be(orc mc this day ot ~ c~~ a o 2 c Si
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ROGER P01 TRAS. CLERK OF C IRCU! T_COUf2T
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ST. LUGIE COUNTY, FI.ORiUA • . ~
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BY: '
FPUTY LERK , ~ ~
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b0~ AGO Forn~ 9! ~ : ~
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