HomeMy WebLinkAbout0138 Dec~arat~on of Domic~l~ and Citizenship
TO TItE CLERK OF Tl~E CIRCUIT COUftT.
ST. LUC 1 E COUNTY. FLORIDA: '
,
TAis b my declaration of Pomicilc and Cittsenship in the Stalo ot Florida that I am Wing this day in accordanco, and in ~
tonformity with Section 222.17. Florida Statutes.
I was tormcrly s Ic~al residc~t oi Q5 . N'~' ' end 1
ICity1 IStatel
tesided at j`~ g G' t't- ~ 5 1' . Nowov~r. I hsve ehanged snv doniicile to
(Strret wd NumDerl
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and am and havc been n bona Gde resident ot thc Stalc of Florida since ! J dsy ot
`.rU`~`~{'-L .19~~. and 1 reside at. f C3 `7 N~~' - t"~ I~.~ L. r.J~J ~ u~. .
IStrcet snd Ivumbed
FcstZT' ST. 'LUG I E _County.Flocidn,
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nnd tAi~ statement is ~o l~r tsken as rny declarx?ion oi citize»ship. actual legal residence arid domicile ui lhc: S2ate oi Flori:fa, '
IF FOR TNE f'URPOS~ Of E~~ROLLING IF f'OR tiOMESTEltO PURPOSES~
C?iILDREN It: SCttOOL~ PIEASE STATE PLEASE CHECh:
THEIR tiAMCS2 j
C l~+ri~ s~t f}~~J kt'~.Ysc~c~t~
Ff~Eii ~ 9 K~~tifDfU
ST luCi~ ~evNii~ ~LR- ~
- ~G6fR Pplr
Fc;• C;F.YUIT ~'U.
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ti
Qci I~ 2 P2 P~'~$~,;
~~375
I FUP.TIiF:R CF.R7'I~'1 that I w•iil mgisier at my Ic~cal addre~s whet: the registration books reoF?en, xnd coir.ply witl~ ali ~
other requiremrnts oi a legal ~esident oi this Stxtc.
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1 E'ItRTH4~::t C'};I:TihY thz! I ha~e no intcnti~n to rctutn tn m1• [urmer d~micile, and I intend to Mftl~[D in ~
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E'lorida, ~~crn::snenci,. ~
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Sw•~~rn tn and ~.atrscrib~d bz•fnrc rtse thes ----~`-JL~-. day of r-+ ' ~ Y ~:l l~- r= i--A ~
~ ~~_T. L°~i~ _ , A.U.19_ 7 ~
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RnG~fZ POi TF2AS CIERK OF C IRC.UI T COl~2T ~ ~
- - - - ~
ST. LUC?~~ COJtJTY, FL0~21UA . ~
BY: ~ `
- e~urY LERK
~ goa~ 2~ ~?~E i38 .
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