HomeMy WebLinkAbout1180 Declaration of Domicile and Citizenshi y ~
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TO THE CLERK OF THE CIRCUIT COURT.
ST. - L UG I E COUNTY. FLORIDA: .
This is my deelantioa of Domiede and Citizenship in the State of Florida that I am filing this day in accordance. and in
conformity with Section 222.17. Florida Statutes.
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I was formerly a legal resident of ~ ~U ~ ~ O /\/fW u~/S and I
fJ ILl't~l !State)
resided at ~~~E ~~D- V ~ ~ ~ - . However. I have changed my domicile to
13treet and Number)
and am and have been a bona fide resident of the S4te of Florida since ~ ~ ~ - ~ ~ r ~ day of
laf'~Pi~ .19z 4 . and I reside at ~~40 Jd~/r~' ~ f
~ ~T, ~C o T 7
_ (Strut sad Number)
t ~ - ~ S T . L UG i E County. Florida.
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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 Oi' ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKI
THEIR NAMESt
~C'H~9 E SAn'I r
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I FURTHER CERTIFY that I w~71 register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
T. U C I E County,
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Florida. permanence; .
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~ '-•`~~.w~. a~: oaf
~ ~ '~~'CUNTV.F~'
~ (Name)
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S.vorn to and snbscnbed before me this day of
.
A.D.19_ ~1 - ~ _
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ROGER POI TRAS, CLERK OF CIRCUIT COURT
•
ST. L UG I E COUNTY, FLOR 1 DA -
BY:
EPUTY LERK
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