HomeMy WebLinkAbout2997 431545
TO TI11': CLT:1tK OF'f11E C1HCi1fT CQURT,
ST. lUG I E _COUNTY, F1.01tIDA:
This is my declaration of Domicile and Cilirrnship in the State of Florida that I am filing this day in accordance, and in
conformity with Section '.rZ2.1?, Florida Statutes. .
I was formerly a legal resident of ~ I
tLtit 1 (State)
resided at . Ifowever, I have changed my domicile to
(Start and number)
and am and have bcetl a bona Cde resident of the State of Florida since day of -
i{ ,19__S_~, and I reside at tg~ ~ NumbsA
~l~L, ST, lUC I E County, Florida,
l~tyl
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida. -
IF FOR TKE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN I N SCHOOt., PI.EASI: STATE PLEASE CHECK! ~
THEIR NAMES2
EiLED A'~D RECORdEI);
' !.!CIE rt1Ut~;TY. t=LA.
- 431545
- X79 J~~ 22 PM 2 : i 4
- 9~~'
C~ Eft, C~RCu1T ';%tlRT-
IFURTHER CERTIi''Y that 1 will register at my local address when the registration books reo, en. and comply with all
other requirements of a -legal resident of this State.
r
I FURTIIE? CERTIFY that I have no intention to return to my former dorni~ile. and I intend to mrllain in
;~!w - - ~ . ~ ~ ~ -County .
ICitp)
~ Florida, permanenti,.
I
:~att~~ _
.s.; s, _
~ ~ +
;s~.
• b (Name) 1J
(Address)
x I • to and subscribed before me this ~ day of 7 ~ i
~ ~ - 3 sires
~ ~1-uc_
~yq '
-&~>=R POI TRAS CL.FI2tt OF G IRC_UI T COURT _
-
ST. LUG I E COUNTY, F t.OR 1 U ~ -
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LPUTY Lt.EftK -
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