HomeMy WebLinkAbout0100 ciaration of Domicile and Citizenship
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TO THE CI.ERK OF THE CIRCUIT COURT.
ST, lUG I E COUNTY. FLORIDA:
This is my declaratioa of Domicile and Citizenship in the State of Florida that I am filiag this day in accordance. and in
conformity with Sectioa 222.17. Florida Statutes.
1 was formerl a iegal resident oi ~~J~ ~~t~~ and I
(City) tat~)
~~~~C7 ~j / /~/~1~ . However. I have changed my domicile to
resided ai
IStreet and NumMr)
and am and have been a bona Cde resident of the State ot Florida siace "L'~ day of
~ ,19~. and I reside st ~11~~
~ (Streec ~od NumDer)
' f C ~ S T. L UG 1 E Count~. Florida, .
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and this statement is to be taken as my declaration of citizenship. actual legal re~idence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF fOR HOMESTEAD PURPOSES~ ~
CHIIOREN IN SCHOOI~ PLEASE STATE PLEASE CHECK: ~
TH IR NAMESS •
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435422
'19 FES 27 aR1 i i: 47
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~ I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and eomply with aU _
! other requirements of a legal resident of this State.
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I FURTHER CERTIFY that I have no intxntion to return to my former domicile. and I intend to remain in
~ ~ T. U C 1 E County.
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~ Florida, permanenti, .
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- Sw orn to and subscr'bed beiore me this day of u~ `5~
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_ . ~_e~1?.~~ , A.D.19_ ~9
ROGER P01 TRAS, GLERK OF G IRCUI T COURT
-
~ ST. LUGIE COUNTY, F~ORiDA : .
~ BY: ~
f;~ EPUTY LERK
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