HomeMy WebLinkAbout1896 z
Declaration of D®micile and Citi~~nshiia ~
438322
TO T)lE CLEItK OF TILE CIRCUIT COURT. -
ST. LUC i E COUNTY. FLORIDA:
This [s my declaration of Domicile and Citizenship in the State of Florida that 1 am tiling this day in accordance. and in
conformity with Section 222.17. Florida Statutes.
I was formerly a legal resident of 2 = ~ Born in Florida ~ and I
IClty) - (Stag)
resided at . However. I have changed my domicile to
(Strut Rod Number)
and am end have been a bona fide resident of the State of Florida since 1\'ovenber day of
9 _ 19 ~ II , and I reside at 2013 s lOt h St .
(3tmst and Number)
Ft . Pierces ST. LUG f E County Florida,
(City) - .
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 PURPOSESa
' CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
~~EO-a~~c ~ECORaEa
_
i.;`C+F. CrUN_TY, FLA.
.I ~1 V 11~ '~L~
438322
9 ~l~
T1~e Adrian ;~t. Sari;~le Scholarship CL~RK ~!RCL'1?' CC.1:n'
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
other requirements o[ a legal resident of this State.
i
I FURTHER CERTIFY that I-have no intention to return tom former domicile. and I intend to remain in
~ U C 1 E ,County.
j ICit~) -
i Florida, permanenti;.
i
i
OU c L~
~ ~?ry ~e FF~ ~ F_ x111 ~
~.•~•i:~fR~-..~. co
j ~ _G
.rl - o" (Name)
t~f IAdde~eae)
Sµ•orn to and subscribed before me this _cz=-S.L dsy of
~l~ , A.D.19_ ~1
ROGER P01 TRAS,~ CLERK OF CIRCUIT COURT
S T. L GOUN~'Y, F L.OR t UA
E3Y: - .
EPUTY LERK U La~05 ,~`f~~n~
;.j
3QG. ,
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. ' Acr) Form 71 2°
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