HomeMy WebLinkAbout0058 . .
' n of Domiciie and Citizenship ~
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, ~ TO THE CI.ERK OF THE CIItCt11T ('AUBT. ~ _ ~ , ~
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• ~ ST. LUC 1 E COVNTY. Fi.oRIDA:
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Tht+ is m~? declaratiou ot Domicik aad Citi~easl~ip to the $tate oi FlorWa that I aoa tilini tl~ d4 ia aeeordsnas. iu?d tn i
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coatoranity ~vith Seetioa 222.1?. F'lorida Statuta. - . ;
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I wa t~ a legal res~dent ot . ~1~~,~ y~r~ ~ '
' . Ho~rever. I bave ehu~ged eU? domicik to • ~
K~a,?t ~39 ~~~,r o,v ,ur~ :
l8tiwt ~d Numbwl i
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and am ~ad have beea a bona ~ide teaideat of the State ot Florjds stooe
n ~ .l 1~ , . ~ ~57~
~ll t!'/1l~ 19~.. ond I reside at ' ;
- ISerMt N~obKl ;
~S~ L' / P _ ST . LUG I E Count~. Florida. ~
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and this statemeat is to be takea as oiy deelaratioa ot citisea'ship. aetud kgsl residenee and domicle iA t6e State of Florida. ;
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I`P FOR TNE PURPOSE OF ENROLLING . IF fOR NOMESTEAD PURPOSES~
CHIIOREN IN SCHOOI~ PLEASE STATE PIEASE CHECKS ~ _I
THEIR NAMES: .
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. ~,~,Ea ~ND RECOROEO~
- : ~~r~c CQUNTY, FLA.
- . - ~Jc RIF'E~
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I I FUKTHER CERTIF'Y that I wr~71 reg~ster st my iocal addres~ when the regestntioo books reopen. and oomply writb all ;
~ other requirements ot a legal resident of this Statc. - F
~ I I~'U CERTIF'Y tha I have no intention to return to my former domicile. and I intead to retnain in 3
~/?.er Lf C~/Q ST. Luc i E _Councy.
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Florida. permanenti; . '
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~ Sworn to and subscribed before me this _L____ day ot
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~ , A.D.19.~ . ~
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-~s~. ROGER P01 TRAS CLERK OF C IRCU{ T COURT ,
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~ ST. LUG I E COUNTY, f I.OR 1.UA ?
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, BY: .
EPUTY IERK ~ =
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~ ~L~~ 301 58
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~t Af O Porm 71
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