HomeMy WebLinkAbout2077 - 434'76'7
Declaration of Domicile and Citizenshi
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TOTHECLERK OFTHE CIRCUIT OOURT. -
ST. LUC 1 E COUNTY. FLORIDA: -
Thb b a~ declaration d DomkDs and Citisensbtp io the State d Fbrida that I am i[tina this dq iD aacordaooe. and Is -
coniormi~ wills 8eetioa 22$.17. Florida Statutes.
U?er-t rah, B QQ ~ti ~ L ~,.da anaI
I was form a kSal rssident d
t~Vl (statel
nailed at A /-e G S o r c,~ oo ~ 1~'o raSfr ~l u 1~ _ However, I have changed a~ domieDe to -
• lBteNt oral NesiD~rl 1 -
and oral and have bsea a boon Sde resident dthe State d Florida since _ ' ~i~.L ~ d~ d
CIA a~cl, ,19
7
` ~ and I rsaide at ~ 9 i I ~ ~ -
l8t~t aadNabrl
f'i- pl r rc e ~ ST. LUG I E Counq, Florida.
and this statement b to be taken as np declaration d citisenship. actual kaal residence and domicile in the State d Florida.
IF FOR- THE PURPOSE OF ENROtLINa IF FOR NOMESTEAO PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: - ~ .
_
-FILED -AND- RECOi~D~O~„ .
c-. L+.ICIE COUNTY: FLA: -
c:~ CORE V~~F~ D
43.4
'Z9 FEB 2 i PN ~2 : 1 ~
• - ~.i`L•~~~ ''qt'r'
CLEi'ci4 C,RCli;T .COURT
I FURTHER CERTTF'lf that I w~71 register at m7 local address when the registration books reopen. and compfij with all
other regnirementa d a legal resident d this State. _
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I F[JRTI~IER CERTIFY that I have no intention to return to former domia'le. and I intend to nmaia in
E _ U C I E _ Count,
F'lorda. (QU)
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Sworn to and snbeer~bed before m~e this ~ / day d .
, A.D.19_ ~1
R~ER P01 TRAS, CLERK OF G IRGUI T COURT
ST. LUG 1 E COUNTY, f LOR t OA -
•oo -
EPUTY LERK U ~
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