HomeMy WebLinkAbout2783 i~•
- f
Declaration of Domicile and Citizenship
.44651'7 -
TO THE CLERK OF THE CIRCUIT COURT. `
ST. LUG 1 E COUNTY, FLORIDA: ,
This is my declaration of Domicile and Citizenship in the State of Florida that I am tiling this day in accordance, and in
conformity with Sedioa 222.17, Florida Statu~tes~~ ~ ~ ~
I was formerly a legal resident of __~,~'rl_" /K.~~ ? ~~1/~ ~~`J~/~ and I
(City) IState)
resided at ~o STi~Bkc~ OR • . However, I have changed my domicile to '
(Sttset aad Number) -
and am and have been a bona fide resident of the State of Florida since day of
_ 19 , and I reside at l? y / /J'`' STR~ ~
tst~t ,aa Number)
ST . L UG I E County, Florida,
ICit7)
and this statement is to be taken as my declaration of citizenship. actual legal residence and domia']e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS ~ !
THEIR NAMES:
1979 JUG -4 A~ ~ 28
f
FILED AlIQ R:COROEO
St.LUC1E t pUt1TY.F~A.
R06ER PrOITRA
- - CLERK CIRCUS LOUR
RECORD vERIF1E0
44651'7
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.
i
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,
Florida. permanenti; .
Y
€ _ - ~
& ;
IN.m.)
team..)
S•vorn to and subsm'bed before me this ~Ti~J day of ~0 2 -T- ~ ~ ~ G L . 3 3 y S
- 9~
3 ROGER POI TRAS, CLERK OF G IRCUI T GOl~2T •
~'`i''~~. ~
ST. lUG 1 E COUNTY, FLOR 1 OA ~ t ~ _ ~ 4
} .
x 3n~,K 309 ~a>;: 2780