HomeMy WebLinkAbout1149 s
Declaration of Domicile and Citizenship ~ ~
- ~
44'7355 .
TO THE CLERK OF THE CIRCUIT COURT,
ST. L UG I E COUNTY, FLORIDA:
This is my declaration of Domict7e and Citizenship in the State of Florida that I am Sling this day in accordance, and in
conformity with Section 222.17. Florida Statutes
I was formerly a Iega1 resident of ~ ~c and I
71 IStatel
resided at ~y~ . However. I have changed my domicDe to
(Street sad Nnmber / - E
and am and have been a bona fide resident of the State of Florida since da of ~
~ I
-19~, and I reside at
(Street and Nomberl
~ J ~
~ - ST . L UG I E County, Florida,
l(~tyl
and this statement is to be taken as my declaration of citizenship. actual-legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOIa PLEASE STATE PLEASE CHECK:
THEIR NAMES: !u ~ - }
~5~~~? i
f919 J!!!~ I I PII 12~ 2 7
~Tf~OGER
POITR
F1A.
CLERK CIRCIHT CO ST Q~ {
- RECJRD ~~Ef.IFtEtt~_~~""
- f
44'7355
' I FURTHER CERTIFY that I wt11 register at my local address when the registration books reopen, and comply with aI!
other requirements of a legal resident of this State. -
I
I FURTHER CERTIFY that I have no intention to return to my former domicHe, and I iatead to remain in
T. U C I E .County,
s ((:Ry! -
i
`s Florida. permanenu;.
E
t
i
Y
d
c
3 _ - \1
§ ~ - ~ i
9
' ' `
' r °
(Nally)
(Addrea)
Sworn to and subsenbed before me this ~ ~ TH day of ~
f -
- ROGER POI TRAS. CLERK OF G IRCUI T COI~tT - ' , 3 =
ST. LUGIE COUNTY FLORIDA -~~s''6~-•'' .;.,:~~.~r'. ~
_ ~
• . ; a~ azr -
310 ,,~.:~.i~49 -~:~.~~-~a~~
rJ~
~;i
~ 9