HomeMy WebLinkAbout0351 Deciaration of Domicile and Citizenship '
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TO TIIE Ci.ERK OR THE CIRCUIT COURT.
ST. LUC 1 E _ COUNTY. FLORIDA:
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Tbis b mp decluation ot Domicile aad Cit~eoship ta the State ot Florida that I un Gling thb dq? ia aeoordanoe. and in
eoniormiiy witA Section 222.17. Florids Statutes.
I wa Iormerl s kgal resideat ot ' ~ I
IStatd
6250 ~ laple x Rt. I box ~ domicileto
resided d~ Hawever. I have ehanged tqy
18teNt aad N~mb~rl - .
Dec. 29, I978 ~y~
and am and have been ~ boaa t~de resideat ot the Stde of Florida sinee
-19 - and I reside at 49I 3 Myr t le Dr i ve
18te~t ud Numba)
Fort Pierce_ . ST. LUG 1 E Countr, Fbcida.~
and this statemeat is to be talcen as my dacluatioa of atiuaship. aetual kgal resideaee and domic7e ia the State ot florida.
• If i0R THE PURPOSE Of ENROLLING If POR HOMESTEAb PURPOSES~, ,
' CHILDREN iN SCHOOI~ PLEASE STATE PLEASE CHECK2 ~
THEIR NAMESS .
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43365'~
'79 ~ ; " I 2 P41 ! : 07
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I FURTHER CERTIFY that I~rill register at my loca! address when the registration booka nopen. aad wmP~y M?ith all
~ other requirements of a legal resideat ot t6is State.
` I FURTNER CERTIFY that I have no intention to return to m tornner domicile, and I intend to rerruin in `
~ . L U C 1 E . CowitY.
l(tiql .
~ Florida. permanenti; . '
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Sworn to and subseribed betore me this ~ cisY ot
~ . A.D.19_ 79
~ ROGER P01 TRAS, CLERK OF' C I RCU I T COURT . ;
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ST. LUGIE COUNTY, FLORIU •
BY: ~
E P U T V l E R K bOOK
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~ I ' Af.n F'orm 71 22 i
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