HomeMy WebLinkAbout0436 Dectaration of Domicile and Citizenship
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TO TIlB C1.ERK OF' THE CIRCUIT COUItT.
ST LUC 1 E CovN'1'Y. FiARIDA:
This b my deelaratlon ot Domlcile and Ctlisenship !n the State ot Florid~ that I am Cling this d~r iu aceord~?aoe. and in
tanfortnity ~vith Seetioo 222.17. Florida Statutes. .
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1 wa focmerl a legal resideat ot 1~~ tetate)
S U However. I luve changed aU? domicik to
resided at ud Numb.tl Q
day o!
and am and b~ve b~en a boa~ tide reaident ot the Sta~e oi I~'Mrida sines
~~EB,~! 19~. and 1 reside at ~Z /l ,E~ T/l/1 ~E 7~ff~~~i
(8t~+.t ~.d~NumbK) ,
S , ST . lUG i E County. Florida.
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~nd thu statement is to be takea as my declaration ot eitizenahip. actud legal residence and domicile ia the State oi Floride. ~
~ , IF FOR HOMESTEAD PURPOSES~
If.POR THE PURPOSE Of ENROLLING p~EASE CHECK: ~ ~
• CHI~OREN IN SCHOOL~ PlEASE STATE 7
THEIR NAMESS ~
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; I I~'URTIiER CERTIFY that I will register at mr loca~ address whea the registrstion booka reopea. and oom ly i
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~ other requirements ot a legal resideat of thiu StaLe.
! FiJRTHE~ CF.RTIFY that I have nu intrntion to return to m former domicile. and I intend W remsin in
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Fbrida, permanenLi; .
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~ Sworn to and sub~eribrd betore me this
~,~i3~n.c~ . A.D.19_ ~ 9
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ROGER P01 TRAS, CLERK OF C IRCUI T COI~tT ~
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ST. LUG 1 E COUNTY, FL.OR t UA ~
BYs I.
_ EPU7Y LERK .
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