HomeMy WebLinkAbout2578 Declaration of Domicile and Citiienship
• .433139 .
TO THE CLERK OF TILE CIRCUIT COURT. •
ST. LUC 1 E OOUNTY. FLORIDA: .
Thb b mIr deelaratbn of Doaakik and Citizenship in the State of Fbrida that I ua Cdina this dq to aooordanee. and in
contorenity with Suction 222.17. Florida Stat
at ~ and I
I was tormeLZtiirl a legal tCWrl i81~N1
resided at However. I Rave changed aqr domicile to
letnd gad NMIKI
and aea and have been a bona Gde restdeat of the State otFlorida aiaos - dar of
1 and I reside at ~ .
~ t8tnrt as! NnsMd -
_ ST. LUG 1 E - Couoy. Flor;d~ -
tcwl
and thb statement b to be taken as aq? deeLntion of eitbenship. actual legal residence and donnieik fA the S4te of Florida.
IF. FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAO PURPOSES,
CHILDREN IN SCNOOt., PLEASE STATE PLEASE CHECKS
THEIR NAMES: -
Ff~EO ANO RfiC~!l~i~'!
S'. t_UCIE COUNTY:•ELLA:
• ::=~OR~ VERIF;ED
- 433x39
'~9 FE8 6 . AM I I : 42
CLERK CIRCUIT COURT
'
I FURTIiER CERTIFY that I w~71 register at my local address when the registration books reopen. and compb with all
other requirements of a legal resident of this State.
{ I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
__s
f .County:
c '
I l _a.ys. (fit l ~ - -
v:.~ .~av ~ .y
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IN~I
(Addnsal
S.vorn to and subxribed betoro me this ~ daF of -
~
4
~ ry9 ~ -
A.D.19_ / 1
ROGER P01 TRASH CLERK OF CIRCUIT COURT
a
ST. LUG I E COUNTY, f FOR 1,U
BY
EPUTY LERK q~
• SQOKtwair !'M~EIW~
. ~ . .
ACO FormTl 23
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