HomeMy WebLinkAbout0470 ' ' ' Citi~enshi ~ ~
Dec{aration of Domicite and p
~ 35668
TO THE CI.ERK OF THE CIRCUIT COURT.
ST. LUC I E Cpvt~TY~ FLORIDA: _
This is mp deeluatioa of Domicile a~d Citiaenship In the State of Florida that 1 am filing this da~ ia ~?ccordance. and 'w
conformity ~vith~Seetioa 222.17. F'torida Statutes.
ANDERSON GOUNTY~ TENNESSEE ~I
I was formerl a kgal resideat of -
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resided a: 0. 80 X 14 5 . However. I have changed my domicile to `
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and am and have iken a bona fide resideat oi the State of Florida since 2 ~T H da~ oi ~
OCTOBER 19 7g -andIresideat 2860 WI LTSH IRE TERRACE ;
(3tre~t u,d NumD.r)
PO R 7 ST . L u C 1 E ST . LUG 1 E Count~, Florida, i~
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and this ststement is to be taken as my decluatioa oi citizenship. actual legal reaidence and domic~e in the State ot Florida. i;
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IF FOR THE PURPOSE OF ENROIIING IF FOR HOMESTEAD PURPOSES
CHILOREN IN SCHOOL~ PLEASE STATE P~EASE CHECK: ~
THEIR NAMESt
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i I FURTHER CERTTFY that I will register at my local address when the registration books reopen, and comply with all
! other nquirements of a legal resident of this State.
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~ I FURTHE~ CERTIF'Y that I have no iatrntion to return to my former domieile, and I intend to remain in
j _ 5T . L U G 1 E County,
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~ Fiorida. permanensi~.
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(Addrea)
- Sworn to and subscnbed before me this day of
~ 9
~ . A.D.19_ ~ 1
} ROGER POI TRAS. GLERK OF G IRGUI T COI~tT
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~ ST. L IE GOUNTY, FLORI~A
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~ BY: -
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~ EPUTY LERK .
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