HomeMy WebLinkAbout0164 ' of Domicile and Citiz~nshi ~ ~ _
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TO THE CLERK OF THE CIRCUIT COURT. .
ST . L UC I E COUNTY. FLORIDA:
This ia my declaratioa of Domicile and Gltizenship in the Stste ot F7orida that I am tiling this day in accordance. and in
conformity with SectioA 222.17, Florida Statutes.
I wras formerl a Iega) resideat ot ~~k~ N~ ~~~~'J and I
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resided st ~~?/J ~I~UN / rt C/~ . However, I have changed my domic~e to
IStrsat aod Num 1
and am and have been a bona tde resident ot the State of Florida since U~/~ diy °t
~~C C/.'I r -19...z~. and I reside at ~ 3 3 J~i ~3~e s•-s~ n U~• :
(Stie~t aod Numb~c)
/~o~ ~ J7; l(/ c: ~/G S T. L UG I E Count~. Florida. ;
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and this statement is to be taken as my declaration ot citizenship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES~ 1
CHILDREN IN SCHOOL~ PLEASE STATE . PLEkSE CHECK: ~
THEIR NAMES: ~ ~
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! 1 FURTHER CERTIFY that I will register at my local address v?hen the registration books reopen. and comply with all
other requirements of a legal resident of this State.
~ I FURTNE.'~ CERT that I, have no intxntion to return to m former domicile, and I intend to remain in
T. U C 1 E _ County.
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c Florida. permanenti;.
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Sworn to and subscn'bed before me this day oi ~ _
~ . ~ ~.c.` ~ . A.D.19_ ~ /
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ROGER POI TRAS. CLERK OF C IRCUI T COt~tT
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~ ST. LUCIE COUNTY, FLORidA . -
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~ BY : .,;z,,.~
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d EPUTY LERK .
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~ ~~3U4 ~64
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