HomeMy WebLinkAbout2587 `~4f'414 Declaration of Domicile aid Citizenshi
TO THE CLERK OF THE CIRCUIT COURT,
ST. LUC 1 E coUNTY, FI.oRroA:
This is my declaration of Domict7e and Citizenship in the State of Florida that I am 61ing this day in accordance, and in
conformity with Section 222.17, Florida Sta----tu~~tes~.
I was formerly a legal resident of _~!<<C4"~`~ _ / "IW , ~ ~ and I
(City) (State)
resided at ~'f ~ - ~ C6 . However, I have changed my domicile to
(Street and Number) ~f ~
and am and have been a bona fide resident of the State of Florida since ~ (x,~ / day of
y/ r?
,19~~.. and I reside at ~ /L f V Q ~~f ~rrtl~ .'Ir 4~-
1 ~ (Street and Numbed
t n1 l . t ~ L ~ ~ ST . L UG I E County, Florida,
tCnyl
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
II• FOR THE PURPOSE OF ENROIIING If FOR HONESTEAO PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
44414
~91~ JU"~ -1 I ~ 35
f ,R?i~ RtCt,'rwtl~
PC
~TRl.Af~A.
- p~I~C411T COURT
- RECARD'~~1Ft_0__~----
II
I FURTHER CERTIFY that I wt11 register at my local address when the registration books reopen, and comply with all
l other requirements of a legal resident of this Slate.
i
f 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,
s
F
~ Florida, permanenti; .
F
. o
~~y ~r~9~s
c,:::r
.L
~j .;o a ` MQLi10.`RygS
~i fir. 1 -
~ • l ~~.c~~~1' -f
` (Addrep)
~ SWOrn to and subsrnbed before me this da of /2 ' ~ r~ t- } j
E : ~ A.D.19
~ ~1 _ -
OG POI TRAS CLERK OF G IRGUI T GOt~2T
a
ST. LUG I E GOUNT'Y, FLOR 1' A -
BY: ~
a
' EPUTY LERK
~ 4
,
R 309 254 ~ • ~ -
sooK - "