HomeMy WebLinkAbout0410 '
Declaration of Domicile and Citizenship ~ f
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446903
TO THE CLERK OF THE GIRCUIT COURT. '
_ ST. LUG 1 E COUNrY. F1.ORIDA: . `
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This is my declaration of Domic~e and Citizenship in the State ot Florida that I am filing this day in accordance. and in
conformit~ with Section 222.17. Florida Statulea.
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I was formerl a legal resident of O ~/e ,~P 4J /~/p~ and I ~
(Cit~l IState)
resided at ~ j C2~~ m A j v1 S T . However. I hsve changed m~ domiu7e to
(Street aad Number)
and am aad have been a bona fide ?~esident oi the StaLe ot F7orida since ~ ~~'S L dil of ~
s
~v ~ .19~~. and I reside at ~i ~ a ~ ~~5~ ~L/Q E'
_ n (Street and Number)
~c~ R/ ~t'i r~ C~ . S T. L UG I E Count~, Florida,
((.l't~)
and this statement is to be taken as my dedaration of citizenship, actual legal residence and domia7e in the State of F7orids.
IF FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAD PURPOSES~
CHILDREN IN SCHOOI~ PtEASE~STATE PLEASE CHECKS ~
THEIR NAMES:
~ !9t9 JU,~ -6 J~H i I~ 38
~ FtLEt3 AAU HECU~D
$ ROGER
POITRASA~ :
CLERK CtEiCU1T COUR~ ~ j
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~ 446903 {
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I FURTHER CERTIFY that I w71 regist,er at my local address when the registration books reopen, and comply with a1) ;
` other requirements of a legal resident of this State. ;
P
e
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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.
~ «71
~ Florida, permanenti~. ' ~
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~ - (Addrea~)
~ _SWOrn to and subsm'bed lore me this dsy of i C
~ ~ A.D.19
~ ~9 -
~ ROGER POI TRAS. CLERK OF C IRCUI T COU2T 1
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~ ST . L lJG I E TY, F LOR 1 OA - '
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~ BY: ~ . _a
~ E TY LERK ~
~ - ~ ~oRK310 ~~~E 410 ~
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