HomeMy WebLinkAbout0867 aeclarati~n of D'omicile and Citizenship ~
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TO THE CLERK OF THE CIRCUIT COURT.
ST . L l1C 1 E cout~rrx. FL.ORIDA: . ;
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This is my decluation of Domic~e a~d Citizeuship in the State oi Florida that I am filing this da~ in accordaace. and in ~
conformity with Section 222.17. Florida Statutea. ' ~
I was formerl a legal resident of 1~ 1a+ °~7~? . yO rk ~d I ~
fCitr) I~tal
resided at ~~6.~ ~~B 3 S 1~ . However. I havc c}~anged m~ dom;c~e to
(Str:et aad Number) - E
and am and have been s bona fide residenl of the State oi Florida sinee ~ day oi ~
i
,~~f?~' ,19 - aad I reside at ~ •3~<i-
(Street aod Number) ~
ST . L UG I E Count~, F7orida,
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and this statement is to be takea as my declaration of cutizenship. actual legal residence and domic~7e in the Stat,e oi Florida.
IF FOR THE PURPOSE OF ENROlLIN6 IF FOR HOHESTEAD PURPOSES~
CHIIDREN IN SCHOOL~ PLEASE STATE PLEASE CHECKS ~
THEIR NAMES:
- 1 ~ ~7~ss
~
~ 19~9 JL'~~ -8 A~ 3~ 58
FILEO Ah0 FE~un~co
~ ST.lUC1E COUNTY. LA.
a06ER POITRA5
~ _ CIERK CIRCUtT C T`
• RECdRO ~ ERIFIC!t_._
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i I FURTHER CERTIFY that 1 wi11 register at, mp local addresa when the registration books reopen, and compl~ with ill
~ other requirements oi a legal resident of this State.
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€ I FURTHER CERTIF'Y that I have no intention to return to my tormer domic~e, and I intend to remain in
! T. U C t E . Count~.
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~ Florida. permanenti;. -
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(Addisa) ,
' Swrorn to and subsrnbed before me this ~~nc% da~ of ~j k~.t 3
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~ _ ~~~~s~~~ - A.D.19_ i
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~ ROGER POITRAS CLERK OF GIRCUIT GOU2T
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~ ST. LUG I E COUNTY, FtOR 1 DA ~
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~ BY : i~a~~'~cG ~ ...Q, -
E P U T Y . L ~
~ , 3URY J~l~ ~a~t J~_/ .
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