HomeMy WebLinkAbout0757 D~ca~ra~~c~r~ og C~~mic~t~ anc~ Ci~izens~ip
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TO TiIE CI.}:ltK Of' THF. CIRCUIT COURT~
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This i~ my dccls~ation o[ Domicilo and Citizeoship in the State ot Flocida that I am titing thL+ dsy in accordance. a~d in
eonto~mity with Srction w.rt.i7. F'lorida Statutes.
1 wa~ tormerl a legal resident of ~t~/a~ L~~ i U~: ~~V ~~~/D~~: ~•~,r~~t{/ J a,nd I
f~'- ~ IGitr) 1~e1 -
resided at ~.~~~57 , However. I hsva ehanged my domicite to
(Street and Numbatl
~nd sm and hsve been a bons fide resident oi the State of Florida ~ince ~--s~' day ot
Nt~i~~l~ctr . I9,~, and 1 reside at ~ ~;tfl~(•~'S%' V'c
(3tr+st snd NumDsrl
n
~v,E7 StT. ~~11C~! E ST. LUG I E County. Flocida,
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and this statement is to be taken as my declsration o[ citizenship, actuel legel residence snd domicile in the Statc of Florida.
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IF FOR THE PURPOSE Of ENROItfNG IF FOR NOMESTEAD PURPOSES~ "
CNILDREN IN SCHOOL~ PLEASE STATE PLEASE CHECKt ~
THElR NAMES:
~ . ~
~FILED AND RECORDEO; ,
~T. LUGlE COUNTY. FLA.
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'78 NOV 20 PM 2: 4~ ;
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CL~RK C~~?C~~T : (:UnT
1 FURTHFR CERTIFY that I will register at my locai address when lhe registration books reopen, and comp)y with all
othcr rcquirements ot a legal residenl of this State. ~
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1 FURTf{fi:t CEILTIFY that I h~ti~c• no intrntinn to rcturn to m• former domicile, . and I intend io remain ia
- ~ - . U C t E . County. ~
(CitJl .
Florida, pcrmanemi; . ~
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~ /~,fG ~:i~~f'ct~~i~ST"~i''
(Addres.) - ~
~w•orn to and suhscribrd hefore mc this ~ p day of f'~(~ IE''T ~/~,[~,~w ~~,~J
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ROGER POI T~2AS. Ct.ERK OF C IRCUI T COURT -
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ST. LUGIE COUNTY, FLQRIUA
BY: ~ ~ ~
EPUTY t,ERt:
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~ Act, F,~~n?
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