HomeMy WebLinkAbout0373 Deciaration of Domicile and Citizenship ~r'
44~098
TO THE CLERK OF THE CIRCUTT COURT.
ST . L UG i E ~pU~.y, ~,p~A:
This is my declaration oi Domic~7e and Citiaenship in the State ot Florida that I am Gling this day in seoordance~ and in
eonformity with Section 222.17. Florida S4tutes.
I was formerlq a legal resident af ~~D~ ~A , and I
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resided at Zg Z y ~GA~t/2~iC//fJ('.- f/¢ ~ . However. I hive ehanged my domiu7e to
. . t8treet aod Nnmber)
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and am aad have been a bona fide resident of ti~e Stste of Florida since ~
~Y2/ L- _ 19 and I reside at _ ZG ~q ~Ot-?~~/
(8trest aad Nnmber)
~oJZT- ST. ~ c~ c~E ' ST . L l1G 1 E Count~. F7orida.
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' and this statement is to be taken as my declaration of c~tizenship. actua! legal re~idence and domicile in the State ot F'lorida.
IF FOR THE PURPOSE OF ENROLLING - IF FOR HOMES7EAD PURPOSES~
CHILDREN IN SCHOOL~ PLEASE STATE ' PLEASE CHEtK:
THEIR NAMES: ` ~ .
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G~~v~
i919 i~AY -3 A.~€ I1- 2S
• . ST LUCIE
COUNTY f1.A.
. I~06ER POITRAS
CLERK CtRCUiT COl~RT
RECGP.D YEf!:FtE~ 4- ts ~
4430~3~
I FURTHER CERTIFY that I will r~gister at my 1oca1 address when the registration books reopen, and comply with aU
~ other requirements of a legal resident of this Siate.
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` 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.
~ ICit~1 .
E Florida. permanenLi; . - !
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S.vorn to and anbscn'bed befora me this day of t'~~% ST. L~iE ~L
- - ~ -
~Q`~ A.D.19_ ~9 .
: ROGER POITRASs CLERK OF GlRCUIT COU2T ~
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$ ST. LUG I E GOUNTY, FLOR t OA ~
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BY: U~
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EPUTY I.ERK '
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