HomeMy WebLinkAbout0172 Declaration of Dan~icile and C~t~~enship ~
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416686 . .
TO T1IE CLERK OF THE CIRCUIT COURT, ~
ST . L UC I E COUNTY. FLORIDA:
This is my declaration ot Domicile and Citizensbip t~ the State of Florida that I am Ciling thu day in accordance. snd in
eontormity with Section ~.17. Flo~ida Statutes.
I vras tormerl a1eg~1 resident ot ~ S~ a~C ~ o , l~~ - and I
ICit~! tStatal
resided at 2 3"') ~N . ~~4 ~~C, y~ ? t• . Horvever. I have ch nged my domicile to
(St.eee ae?d Numbsr) / ~ ~ ~'l
and am and have bee~ a bona Cde resident ofthe State ot Florida sincc C r. J s
7~_ day ot
~ v~~+ .19~ 6- and I_ reside at L J~ C~ C~ ~ T~~ t 7~
l3t~e~t and Nnmber)
17 p,~~ ~ ST~. l UC I E Couoty, Florida,
(Cit~) .
and this statement is to be taken u my declaration ot citizeaship. actual kgul resideneE and domicile in the State o[ Fbrida.
IF FOR THE PURPOSE OF ENROLIING IF FOR HONESTEAD PURPOSES~
CNIIDREN IN SCHOOL~ PLEASE STATE PLEASE CNECK: ~
THEIR N/1NESt
FILED AND REGO~df ~
- . St- OCtER ONRAS~A
~`FaK ~i~CW~ COUaT
orr ' " r c'
. SEP I I 3 39 PM
416~ibi6
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i I FURTHF.R CERTIFY that I will mgister at my local address when the registration books reopen, and comply with all
~ other requimments ot a legal resident ot this State.
~
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a I FURTfiEZ CF.RTIFY that I have nv intcntion. to r~turn to mv tormcr domicile, and 1 intend to rcmain in
~ - , T~ U G I E . Ccwnty.
k lCit~) .
~ Florida, pcrr.:ancn~i;.
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'4 ~'CUytY. F~~~ (Nune)
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~1 rH ~ ~C C :a
(Addresa) .1
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Sworn to and s~~bccrib~d beforc me this day of l~p /~d ,7 ~ C. ~`Q ,
} : - A.~. ~4. 8 '
~
ROGER POi TRA Cl_ERK OF C IRCUI T COl~2T
- ST. ~UC I E COUt~TY, FLOR 1 Ut1
BY: _
"t ~ EPUTY I.ERK
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BUOK ~94 PACE i ~
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