HomeMy WebLinkAbout0865 . D~ctaratron of Damicii~ ana ~~~~zens~~~~
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TO Tl1E CI.ERK OF TNE CIRCUt'r COURT. , ' • ;
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• sT. ~ uc i e covrr~r. FLORIUA:
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This v my dectaration ot Domi~ile and Cit~eaship in the St~te ot F1orlda that I am fillna thLs day in ~eeordRaee. and in
toaformity with Sectan 222.17. Fbrida Statute~. '
~ ~ /1 / / ~ T" 7~ ~?ad I
I w~s fornncrl~r s k rastdent oi `
f ~curr ~sc.e.~
resided at ~1.~~~.. -k,f~~1L~~ -~'t , - However. I have ct~anged my domicile to •
. ISteMt aad NumLa)
aad am and hava been ~ boaa tide tesident ot tl~ State af Florida sinee dar o!
19_._. and t reside it ~-~r:l' / `~n~ ~
: (St~+st and NuuuoMr)
,~-,C~ ' ST. LUC t E~ Couaty. Ftorida,
(Ctit~l
and this statcment is to be takea u my declacation o( citiun."stip, actuil kgal residence and domicite in the State of Florids.
IF FOR TNE PURPOSE O~' ENROtLfNG ' Ii' FOR HOMESTEAp PURPOSES~
, CHILOREN IN SCHOOI~ PtEASE STATE PtEASE CHEGK: ~
' - tHE1R NAMES: '
, ~
)
fILEp AND tIECORDED
=T.4UCIE COUNTY ilA.
ROCER POITRAS
CLERK C+RCUIT C ~
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- ~ A~c 19 {0 va-~M'i8
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I FURTHER CF.RTIFY that I w~71 register at my locut address when the segistration books reopen. and comply with aU
other requircmenis o[ a Ic~al resident of this Statc. "
I FURT ~ CF.RTIF'Y that I 1?avc no intenteon to retdrn to my former domicite. and I entend to remain in
~ . -~,c _ . _ $T . L UC 1 E . County.
+a • ICit~l .
Fbrida, percnaacnti; .
~&_COU,yry
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! •'•.;!r yto ~p'= : ' ~O ~
G^~F CQ ~i •~SY . 4~.~Q (Nuae)
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Q ' , ~ (Addres~l
Sv?orn to nnd iubscril?rd bctore mc this day ot
i
. a.n. 8
ROGER POI TRAS. C~ERK 4F' C(RCUt T COU2T
ST. L UC ! E COUNTY, f ~O~t i UA •
BY: ~
EPUTY LCRK ' ~E Q~~
0~/Y
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AGO porm 71 ~ '
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~~ta.l'';~`i'"."?~*~„ '`''tlT= ` k`e~ a-aaa~...a.t - - - ' . . - . - ~
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