HomeMy WebLinkAbout1895 t
' ' ' nd Citiz~ns~i ~
Declaration of Domic~lo a ~
438321
1'0 T}lE CLEItK OF THE CIRCUIT COURT,
ST. LUG 1 E COUNTY, FLORIDA:
This is my declaration of Domicile and Cilizonship in the State of Florida that I am tiling this day in accordance. and in
conformity with Section 222.17, Florida Statutes.
i was former} a legal resident of ~ ~
~ BORN I N STATE O F F L O R 10 A and I ,
tpty} 13tda)
resided at . However. I have changed my domicile to
(Stee~t and NwaDsr} '
and nm and have beotl a bona tide resident of the State of Florida since day of
19 - and I reside at ~~n q ~i2~bL H ?t'
(3teest and Nuaab~t)
fi~rrc r` _ ST. LUG I E County. Florida, ;
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
IF.FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
_EO Nc:D RECOROEO
.,TY FLA. t
C..U~.+
. ~
4:38321
'79 23 AM : 38
THE ADRIAN M. S~MPI_E SCHOLARSHIP TRUST ~'+R "Jib CGJ~ + i
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
~ o:h~r requirements of a legal resident of this State.
I -
i
~ I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
> > . u ~ ~ t _ County.
i
~ 1(St~}
Florida, permanenti;.
A
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~A
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ps _ INamO)
~ ~DU~ rA/1GP ~~a1 ~ _
(Address)
Sworn to and subscribed before me this ~.3 day of f"r ~ec~ ~ .
' ~
a _ ~/412GN _ A.D.19_ ~1
5
~ ROGER POITRAS. CLERK OF CIRCUIT COURT
- ~
ST. LUGIE COUNTY, FLORIDA ~ .
BY: "
~ EPUTY LERK
~ptr, tn1~ ~At'f 1Ja`71 _
_ _