HomeMy WebLinkAbout0071 Deciaration of Domicile and Citizenshi ~
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444858
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E ~pv;~'~~ F'I,pRIDA:
This is my decluation of Domicile and Citiunship in the State of Florida that I am filing this da~ in aocordance, and in
conformity w?ith Seetion 222.19. Florida StatuLes.
I was iormerlp a legal nsident oi ^ and I
1 7) 3t+ta)
resided at ~2~~L~`' ~ . However. I have changed m~ domic.~e to
(Stieet aod N Der)
and sm and have been a bona fide reaideat of tbe S4te of Florida since ;~=~tf 3~ ' ds~ of
' 19~ and I reaide at ~ / • ~ ~ ~
(StreK asd Namber)
c'~`'~ .C C' ~ c.~--? ST . L UC I E Count~. Flor;aa,
i(xt7)
and this atitement is to be taken as my deelantion of eitizenship. actual legal reaidence and domic7e in tbe SLte of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES~
CHIIDREN IN SCHOOL~ PLEASE STATE PLEASE CHECKS ~
THEIR NAMES:
~9T9 ~ 8 ~F; i i ~ 02
f1Lf0 A11G Ntl:t~itpEO
i~~
P~OiTRAST .
CI~IK ~T ~~,~Q
R~CQRD VER1r'tEi) ~
444858
I FURTHER CEftTIFY that I~v71 register ai my local addres~ when the regiatra'on books reopen. and comply ~vitb all
other requirements oi a legal resident of this Stste.
~ I FiIRTHER CEATIF'Y thst I have no intention to return to my former domicile. and I intend to remain in
~
T. U C I E .~~ty.
E ICit~l .
j Florida. permanen~i; . - ~
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Sworn to and snbsrn'bed before me this ~ day of
~
/`7 A Sr . A.D.19_ • _
€ ROGER POI TRAS, CLERK OF G iRGUI T GOl~2T
~ ST. LUG I E COUNTY, f LOR 1 OA - '•r.~.
~ BY: . .
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EF'UTY ERK '
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