HomeMy WebLinkAbout0080 Declaration of Domicite and Citizenship '
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418485
TO THE CI.ERK OF THE C1RCUIT COURT.
ST. LUC 1 E ~pp~y. ~,p~DA:
This Is my decG?r~tion o~ Domkile and Citisenahip Ia the State o~ Ftorida that I am Cilias this da~r iA seeordance. and in
contocmity with Seetiot~ 222.17. Florida Statutei.
I~as to~ a kgal ~esident ot C~-~_~ and I
, lCitfl , IStat~
resided at ~ 1~~_C~-f' Horvever. i hav ehaneed mr doaa~cile w `
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aad am and have Deen a boaa fide resideat ot the State ot Florida ainee 7'..,~~ ' z$ dar of 1
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18__. aad I reaide at ~-`1 p~._,~ i
• aod NumD~r) i
.,e,e2 L? ~ , ST. LUG I E Counc~. ~'toriaa,
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aad thu statement is to be takea u my declaratioa oI citiunshtp. setual kgal rtsidenee aad domicile ia the State o[ E'lorida.
If ~OR THE PURPOSE OF ENROILING IF i0R HOMESTEAO PURPOSES~
CHIIDREN ~IN SCHOOL~ PLEASE STATE PLEASE CHECK: ~
THEIR NAMESI
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/ ~ 1~NQ N~C~p~ED
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. SEP 18 10 aa AM'~8
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418485 -
I FURTHER CERTIFY that I wrill register :t my loeal addreas when the registntion books nopen, and eomply ~vith all
' other requirements ot a legal resident o[ this State. ;
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` I FURTHE:~ CERTIFY that I have no intentan to nturn to m fotmer domitile. and I intend to remain in
~ U C I E County.
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~ Florida. permanenci; . ;
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Sworn to and subscribed belon me this day ot ~ 't- ' ~
~ A.D.19.78 /l ~C ~~~C~Za~,~eL . ~.S'~~ .
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~ ROGER POITRAS, C~ERK OF CIRCUIT COU2T
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~ ST. LUG I E COUNTY, f I.OR t UA ~
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~ EPUTY LERK
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