HomeMy WebLinkAbout0310 ~ 4:3'7~;3i /
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~ ~eclaration of Dor~ic~le and Citizenship
TO THE CLERK OF THE CIRCUIT COURT. -
ST . L UG I E ~pUZVTY~ FLORIDA:
This ia m~r declantion of Domieile and Citizenship w the Stt'e of Florida LAat I am filing this da~ in ~ccordanoe. and in
conformity with Section 222.17. Florida Statutes.
I was formeriy a legsl resident of Rnchn~or , ~~ti+ n•*+ I
ICit~l lStac.1 ;
res;ded at 603 Ma d i a on ~ 1 . However. I have changed my domicik to ~
13treet ~ad NamD~)
and am and have beea a bona Gde resident o! the SLate of F7orida since the f i r,~ - da~r ot ,
Januiy .19 79 . aad I reside at ;
13tre~t and umb~) ;
Ft . pierc• ST . LUG I E County. Florida.
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and this statemeat is to be taken as my deelaration of citiunship. actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES~
CHILOREN IN SCHOOL~ PLEASE STATE PLEASE CHECK: ~
THEiR NAMES:
- . ~ ~ ~ ' ~ J C .
- - ? . ~
4:3'7331
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s I FURTHEIt CERTIFY that I w~71 register at my local address when the registration books reopen. aad comply wit6 all
~ other requirementa oi a legal resident ot this State.
P
~ I FURTHER CEBTIFY thst I have no intention to return to my former domicile; and I intend to remain in
r , T. U C 1 E ,(',ounty.
~ lCit~i .
~ Florida. permanenti; .
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= . ;5„_'`::.:~~'~ j.eonard F. Sc~nanv
IName)
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6481 S. Federa l Hrry
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r~~s ~f-sy 3i, 1y78 (Addreai)
~ S~vot~y a~ sYbBe~dbefore me this day of F~. Pi erce * FL_ '~'~GSQ _ _
~ ..r, - , A.D:19_ .
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~ ~RO ' AS ' GLERK bF
G i R~ I T COt~tT
~ ST. LUGIE GOUNTY, f~OR1DA
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~ BY: .
x EPUTY IERK 3~~!~~ ~
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