HomeMy WebLinkAbout0002 Q~c~~ration of Damicile and Citiz~nship
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TO Tilti: CGERK OF THF: C1RCUlT COURT,
ST, lUG 1 E COUNTY. FIARIDA:
Thiu i~ my declaration o[ Domicilo and CitizensAip in the State ot F'lorida thst I am filing this day in aecordanco, and in ~
tonforn~ity vrith Section 222.17~ Florida Statutes. ~
~~.4?(~(.Q71 ~
I was tormerl a legal resident ot « a~nd I
lCit~l IState)
resided at ~ ~ .~Iowever. I have ehenged my domicile to
Sereee.nd Nmober) n
and am and hsve been a bona Cde resident ot the State ot Florida aince day ot
f 5~ _ / ~
19~. and I ceside at ~ 7~/ ,
• ~ (Ste~eet aod NumDerl
~ ST. LUG I E Couaty. Florida,
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and this statemcnt is to be takea as my deeleration ot eitizenship. aetual legul residence and domicile in thu State of FloriJa.
IF.FOR THE PURPOSE OF ENROLLING Ii' FOR HONESTEAD PURPOSES~
CHIL~REN IN SCHOOL~ P~EASE STATE ~ PLEASE CHECK: ~
THEIR NAMES:
FIlEO AMO RECOr f~~.
gT.~uWE CO~~a~S ~
4~OGER R,
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S~o ~i ll Zs AN'1R
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I FtiRT~II:R CERTiFY that I w•il) re~istcr at my ir.:~l address when the rc~,vtration twoks reopen, and comply with all
~ othcr rc~quircments of a te~al resident of this State.
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~ I FURTIIE:t CI~:ItTIFY thzt I have no inter.ti~m to return to m~ f.~rmer domicile, and I intend to remain in
~ _ _ , T. U C.1 E , County,
; lCity) .
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Florida. ~+c~rm~ncnti, .
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- S«•urn t~~ and ~ubscrih~~d hefore r.~c this _ day o[ _
_ . A.U. 19_ / p "
ROGER _ PO 1_ r~AS~_ CLERK_G~ C I RCU I T COlf2T
~ ST ~ l UC I~ Cour~TY, F LO~< 1 UA ~
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BY : _ ~
C I~~ E P U i Y L k R t:
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