HomeMy WebLinkAbout0705 Declaration of Domicile and Citizenshi 4~.
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43'7616
TO THE CLERK OF THE CIRCUIT OOiJ~iT.
ST. LIJC I E ppUNTy. Ft,pRIDA: .
T6is is npr dedaration of Domie7e aad CIt~enship in the State oi F7orida that I am filina this d~ in aeeordanoe. and in
coaformity with Seetion 222.1T. Fbrida Statntea.
I was former a legal rasident ot Lufki n~ t~ Texas ~ I
(G~t~) (~catR)
nsided at 2 07 ~+1h i t e h ous e Dr . . However. I have chaaged aU domia7e to
(8~wc aea NambK)
and un and have been a boru fide nsideat of tbe State oi Fbrida sinos r i f t h ds~ o~
_~~~~_.19..~.~ aad I reaide at .
Pt. St. Lucie ~~N~~ •
ST . L lJG I E ~t~, ~
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and this statement is to be taken as my deeluadon of eitirenship. aetual kgal residenee and domie~e in tLe Stste at Florida.
IF fOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES~
CHILOREN IN SCNOOI~ PI.EASE STATE PLEASE CHECKS ~
THEIR NAMESS
ir~rptta Anr~prs~n?
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~ti. chael Rusinsky - - ` - _ , . _
43'~616
,7g . + ~ i~~i :i : 07
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s I FtJRTHE~t CERTIFY that I wn71 ragister at m~ local ~ddnss when the registration boota reopen. and eompt~ writh all
; other requinments ot a kgal resident of this State.
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~ I FUR1`HER CERTIFY that I have no intention to return to m former domieik. and I intend to remain in
U C 1 E , Count~.
a ((st7) . ~
~ Florida, permanenti; .
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`W 208 Bracken Rd. '
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S.vorn to and sub~en'bcd beiore me this day of • St . Lucie . Fla.
~ A.D.19_ ~9 ' . ,
~ ROGER P01 TRAS, CLERK OF C IRGUI T GOt~2T "
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~ ST. LUC I E GOUNTY, FLOR 1 OA ~ ` ; ~ f`'~ ~ ~
~ ~G`~:~'J&~ ~ " • a .
.i ~ BY: ` ,
~ _ EPUTY ERK - ' .
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F~~ j r~ ~ 1~J . 1~.~ 1 O~ . '
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~ ' ~~t•' AG~~ Form 7~ ~
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