HomeMy WebLinkAbout2769 Declaration of uami~i~e ana ~ii~zerrsn~p
• 431416
TO TIIE CLERK OF TILE CIRCUIT COURT,
i
ST. LUC I E COUNTY, FLORIDA:
This is my declaration of Domicilo and Citizenship in the State of Florida that I am filing this day in accordance. ar?d in
conformity with Section 222.17, Florida Statutes.
I was formerly a legal resident of - ~ ~ and I
. (City) lstat•)
resided at ~ ~ ~ r a .i,r f /S?v . However, I have changed my domicile to i
l8t»at asd Ns~asber) i
and am and have been a bona Gde resident of the State of Florida since ~ g day of
Oc.1~' 197' .andIresideat ~~~'3' . J- F /~y~.v~i~ C/RC LE
18trwt aad NumUsrl
Q t ST L„ ~ i!_= ST. L UG i E County, Florida,
la~,l
and this statement is to be taken as~my declaration of citizenship, actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING ~ IF fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMES. '
. U• ~bF~1 ~ r= iLcU ;,sJU~ RECOROEOt
U .J~c~~L~CiF ~~?U'.TY, ~Li..
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a?~1 19 PM 2 : 2 9
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CLERF: ClRC.::IT ;;~'JR'+
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
j other requirements of a legal resident o[ this State.
'r 1 FURTHE3 CERTIFY that I have no intention to return tom former domicile, and I intend to remain in
T. U C I E ,County.
f
(Cit~l
Florida. permanenti; .
r
f ' ;5.14, ~ (Name)
(Address)
Sworn to and subscribed before me this day of
q i
n:n. 19_ ~ / .
L OGER P01 AS LERK OF CIRCUIT COUF2T -
Q •
} ST. LUC I E COUNTY, F FOR 1 UA
BY:
EPUTY LERK
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8~~~ ~1 ~r.~f ~i764
AGO Form Zi °2
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