HomeMy WebLinkAbout2155 Declaration of Domicile and Citizenshi - ~
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446155
TO THE CLERK OF THE CIRCUIT COURT,
ST. LUG 1 E courrTY, FLORmA:
This is mJ decluaiion of Domicile and Citiaenship i.n the State of Florida that I am tiling this daJ in accordance. and in
conformilJ with Section 222.1?, Florida Statutes, t II 1
I was formerly a legal resident of ~D 1r 1~ ~ ^ a ~ h ~ T ~ e • and I
ICit~) ISaate)
resided at ~ ~ 1 ~ • M C Q ~ J¢~/.~ . However, I have changed my domicDe to
(Street and Number)
and am and have been a bona fide resident of the State of Florida since ~ ~Ry daJ o ~
,19__, and I reside at ~G 7 y. C • .L YQy ~ ~ ~C OQ:G+t'
/gyp .5~. ,L ~ / C! ST . L UG I Estr~et aaa Numb)
CountJ. Florida,
lCit~)
and this statement ~ to be taken as my declaration of citizenship, actual legal residence and domia7e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHIIOREN IN SCHOOL, PEEASE STATE PLEASE CHECK:
THEIR NAMES:
;919 h.'<.Y 30 PM{ 2~ ~ 3
f1tE0 AttO kECUtiuEO
ST~oGfR
P01TRA~~
- CLERK CIRCUIT LOUR
RtCORD YERIfff^~- '
446155
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and complJ with'sIl
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 ~ CounLJ~
ICit~) -
Florida, permanenti~. !
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E
COUNTY
E J
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tJ r cj
p U ~f COU~ij O
i 1 (AddrerlT •
Sworn to and subscribed before me this ~ day of _ _1~0 ~r ~ y C ~ e ' T
~j 9
v~ C Q`'~~ A.D.19
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ROGER POI TRASI CLERK OF C IRGUI T COURT
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ST. LUG I E COUNTY, FLOR 1 DA ~ -
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EPUTY LERK '
- - - 3~~. X09 a~~~2152~ _ ~ ~