HomeMy WebLinkAbout2649 Dec~arat~o~ ~t uom~c~~e ~ncx ~~~~~~f~~s
4313~~
TO TILE C1,l:RK OF TIIE CIRCUIT CAURT.
ST. LUC 1 E COUNTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Fbrida that I am Wing this day in accordance. and in
conformity with Seclioa 222.17, Florida Statutes. -
O~ n 1,~Q _ ~ Qom?-
-~nt'~ and I
I was former) a legal resident of c
ICit~l (bYate)
resided at ~ ~ ~ ~ . However. I have changed my domicile to
• (Street and Number)
and am and have been a bona fide resident of the State of Florida since day °f a
\
~ 19~~ and I reside at `~OOI ~U~~ "~1J`a.~1 ~1~ ~L ~ l
l8tn+t and Numbed
ST. LUC 1 E Co~:t~ty,-florida,
ICitr) E'
and this statement is to be taken as my declaratioa of citizenship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE Of ENROLLING IF FOR HOHESTEAD PURPOSES
CHILDREN IN SCHOOLS PLEASE STATE PLEASE CNECK:
THEIR NAMES: ,
i
.
~,t CO RECORDED t'.
• - CCU"tT`~ F~A.-
' 40
. '79 ' ~ 8 . r~
,l:; .
_ _ ~
I FURTIIER CERTIFY that I will register at my local address when the registration books reopen. aad comply with all
ocher requirements of a legal resident of this State.
i
I TI R CER'~IFY that I have no intention to return tom former domicile. and I intend to remain in
7. U C I E Counly.
s Fbrida. permancnti;.
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'ice 1~ .1' \
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tAddres.l
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Sworn to and subscribed before me this _.__L__U day of ~ ~V
R POI TRAS ERK OF C IRGUI T COUNT
ST. L E COUNTY, FLOR 1 UA - - -
8Y:
I:PUT LERK
t;,,~26~4
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3 i AGO Form T1 2.'' _
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