HomeMy WebLinkAbout2496 Declaration of Domicile and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT,
ST . L UG I E covrlTY, FLORIDA: .
This is my declaratioa of Domicile and Citizenship in the State of Florida that I am filing this day in aeoordanee. and in
conformity with Section 222.17. Florida Statutes.
I was-formerl9 a legal resident of . a C° G_ t [1 , ~ tv o~-9 ~ a ~ and I
n tG5ty1 IState)
resided at Noi-L~`i l d h~ ~ l- ~OCt ~ . However. I have changed my domicile to
IStreet and Nnmbsrl
ahd am and have been a bona fide resident of the State of Florida sipnce ~ day of
N,Ea,llca--,19..'S~~f . and I reside at / ~ l ~ 1 QC SD J~ ~.!/d U
(Strut and Number)
. p/ h ~ S T . LUG 1 E County. Florida.
ICttyl
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 CHECK2
THEIR NAMESS
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r.. ~ pt.~ i~ : 2
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State. ~ ~,r, ~ - ~
I FURTHER CERTIFY that I have no intention to return to mp former domicile. and I intend to remain in
T. U C I E ,County.
(Cirty)
E Florida, permanents; .
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• . (Name)
(Addraea)
Sworn to and subsrn'bed before me this day of
. A.D.19_ "
ROGER P01 TRAS, CLERK OF G IRGUI T GOURT
ST. LUGIE COUNTY, FLORIDA
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. EPUTY LERK r, A '
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