HomeMy WebLinkAbout2156 ~t
Declaration of D®micile and Citia~nshi~ ~f'
44'73
TO T}lE CLEItK OFTHE CIRCUIT COURT, '
_ ST. LUC I E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am riling this day in accordance. and in
conformity with Section 271.17, Florida Statutes.
I was formc~lY a legal resident of ~ ~ A ~ ~ S Q W Q G- Q ~ ~ and I i
(City} (State) '
resided at ~ ~ G~J ~ A v o >:~2 A'it" . However, I have changed my domicile to
(Strut and Number) -
and am and have been a bona fide reaiden! of the State of Florida since 't'~ o day of
~`I AfLc~.l 7q o9 ~"I~l~SriA ~Aa•~
_ 19 - and I reside at ~
(8treet and Number}
/-0 2T ~ ~ ~ +z c ~ ~ ST . LUG 1 E County. Florida,
(ahl - ~
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
IF.i'OR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSESa
' CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKi ~ }
THEIR NAMESt
/`'7g12~~. SuL wt`~LS
Ft! EO :•13D RECOR~Eb3:
` LI:C?r COUNTY. FI.A•?
i
,~9 ~ 26 AM 9 : y?
_ _
C1_ERK CsnClilT COURT -
-
1
I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and Comply with all
o:hcr 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
U C 1 E .County.
ICit~)
t Florida, permanen~i;. -
~ ;
3
6
f
" ?
a
(Name)
(Addrsee)
x Su-orn to and subscribed before me this ~O day of ~O i~ t •r ~?C~
- 9
ROGER POI TRAS, CLERK OF CIRCUIT COURT •
S T . LUG 1 E COUNTY, F LOR 1 UA , - t'~~^:
BY; -
I ~ - ~
EPUTY RK - -
~ f~ J~ rr
ACf) F'~am 11 22
•