HomeMy WebLinkAbout2795 Declaration of Domicile and Citizenshi
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4.48445
TO THE CLERK OF THE CIRCUIT COURT,
ST. LUG i E COUNTY. FLORIDA:
This is my declaration of Domict~e and Citizenship in the State of Florida that I am filing this day in accordance. and in
conformity with Section 222.17. Florida Statutes.
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I was formerly a legal resident of Q_ _ and I '
resided at ~G ~ ~~R ~iq~ . However. I have ehanged my domicile to
f Street and Number)
and am and have teen a bona fide resident of the State of Florids since ' dal ~
~ ~ .19 ! 1 . and I reside at ~ /t-~L' e~ -
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B ~ S ~ u / Q , ~ ST. LUG I E~.aaNamber) County. Florida,
IGSty)
and this statement is to be taken as my declaration of citizenship, actual Iega) residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HONESTE-AD PURPOSE ,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR ANESI
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~~~9 ,I,,.. 19 ~ 1. i?.: c.3
TIED Ahl~ ItiCG~l%CO
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ROGER
POI7RA~A
p.ERK CIRCINT COU
448445
I FURTHER CERTIFY that I wt11 register at my )ocal address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
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.
ICrty) ' ~
Florida, permanenti;.
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Sworn ~ and'subsmbed before me this day of / ~ b ~ r ~ - ~ C1 e ~ ~
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A.D.19
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POI TRAS. CLERK OF CIRCUIT COURT
ST. IE COUNTY, FLORIDA -
BY : r,
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