HomeMy WebLinkAbout1814 tion .of Domicile and Citizenshi ~
Dec ara p ~
4.3416
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UC 1 E COUNTY. FLORIDA:
This is my declaration of Domicile and Citizenship in the Slate of Fbrida that I am filing this day in accordance. and in
conformity with Section 222.17. Florida Statutes. f
I was formerlp a iegal resident oi~~ ~~~o ~ / ~ ~ ~ and I
1(yty) lStatd
resided at 7- L ~ ~ ~ f . However. I have changed my domicile to
(Street sad Number) `
and am and have been a bona fide resident of the State of Florida since ~ Tf~ -day of
_~p ~ ~ ~ .19?
Cr and I reside at ~C~ s -sue/ l~P.t~~ /.~DG GIB
lStreat wd Number) .
f L (~G / ~ ~ ST . LUG 1 E County. Fbrida.
laty)
and this statement is to be taken as my declaration of citizenship. actual legal residence and domic~e in the State of Florida.
If fOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS
L ~ n~~'
l t/ ~L W P~f
T,-
_TG(IPP~ ~ el ~ Vim- ~ _ rt;I ?I:~ L:=GORGED
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Pa ~ /~,y~ a y 6~ f"`i ICU ~ 5 ~ - ~ 3F41F??
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHERER that I have no intention to return to my former domicile. and I intend to remain in
~ T. U C 1 E . County.
ICit~)
w t
Florida. permanenti; .
f
4
E
E
~J . G
. (Name)
(Addrea)
Sworn to and subscn'bed before me this ~ day of ~~.J~'~[° F~D / /
. A.D.19_
ROGER POITRAS, CLERK OF CIRCUIT COURT
ST. LUCIE COUNTY, F1`ORtOA
i BY: sz .
s EPUTY LERK ~
year 3U4 ~~~=1812
Af,O Form 71
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