HomeMy WebLinkAbout1704 ' omicile and Citizenshi
Declaration of D p
X38231
TO TILE CI.EItK OF THE CIRCUIT COURT.
ST. LUC I E COUNTY. FLORIDA:
This b my decluation of Domicilo and Citisenship In the State of Fbrida that I am tiling this day in accordance. and is
conformity with Section 222.17. Florida Statutes. n
rAS ~1'cfl~.~-C+t...~ ~ andI
I was tom a legal resident of 1
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resided at 77 7 ~ Rdlr1.~ _ However. I bave ebanged my domicile to
(8treat and N„a~estl
and am sad have been a bona tide resident of the State of Fbrida since ~ day of -
.n*~ ,(_,..rn _ 19.~4~. ana I reside at ~ o ~ ° i S~ ~,~A
` - - (Strsat sad Num~l
O ~ ST . L UG I E . County. Fbrida.
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and this aUtea~eat is to be taken as my dec4ratioa of eitiuaship. actual legal residence and domicile is the State of Florida.
• IF.FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAO PURPOSESr
CHIIbREN IN SCHOOL, PLEASE STATE PLEASE CHECK!
THEIR NAMES:
~1~rQ i.ND RECOROEO'
- GCUNTY, FLA:
' - 438231
'79 NCR- 2 2 PN i: 5 S Q
A
i•.:'~Ei-. i OiT~~~
CLERK ~iriCL'!T CURT
~ I FURTHER CERTIFY that I wdl register at my local address when the registration books reopen. and comply with all
f
j other requirements of a legal resident of this State.
f
~ I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
€ _ l_ U C I E ,County.
1(~t~) - .
Fbrida. permaneati;.
GOU ~JTY/~
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J~~F ccu~r .
/D ~ 01 ~lNaaN~ /1T ~ ~~C e- ~ic~c,o /7 L o).
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Sw orn to and subscribed before me this day of L- ~ 3 ~ ~ 7
Fy c~,~, 9
~ ~ _ A.D. I9_ ~ /
ROGER PO I TRAS,L CLERK OF C i RCU I T COURT -
ST. I E COUNTY, f LOR 1 U
BY:
EPUTY LERK
a~~r 305 r~~E1701
- ACO Form 71-22
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