HomeMy WebLinkAbout0717 _ ~
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Deciaratron of Domicile and Citizenshi
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TO THE CLERK OF THE CIRCUIT COURT. ~
ST. L!!G 1 E ~~:ovi~'tx. ~~wA:
This is m~ dceluation of Domic~e and GStiunship in the State of Florida that I am filing this da~ in aeoordaace. and in
conformit~ witi~ Section 222.17. Florida Statutes.
I w~s formerlY a lega! resident of ~L[ ~~1 ,!~'7 /~~~~1/~ s~nd I
ICit7) IStatel
resided at `~d ~~6 ~ E'aA'"~'v . However. I have eAanged m~ ~omic7e to
lStieet aod Number) ~
and am aad have beea a bona fide resident of the State oi Florida ainee c~ 7~"` day d
~ v~~ 19ZL. and I reside at I~~+Z `r''~ ~~F/ Et D
(Rtro*t ~nd Nnmber)
7 T ! /l~' /~c $T • ~ ~a,."~. i E GouSi~. Florida.
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and this statement is to be taken ~s my declaration of c3tizen~hip. actual legal residence aad domia7e in the State oi Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAO PURPOSES~
CHIIDREN IN SCHOOI~ PLEASE STATE PLEASE CHECK: I--1j
"
THE IR NAMES: ~ ~
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~QT9 J'J'~ 25 AN si~ 36
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~ I FiJRTHER CERTIFY that I w~l register st my local addres~ when the registration books reopen, and comply w~itb a1)
~ other requirements of a legal resident of this State.
P
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; I FURTHER CERTIf'Y thst I have ao intention to return to my former domicile, and I inLend b remain in
~ T. U G 1 E .~p~t~.
i lGt~l .
Florida. permanenci;.
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~ S•vorn to end subscn"bed befon me this da~ oi - -
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~ A.D.19
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~ ROGER P01 TRAS. CLERK OF C IRGUI T GOl~2T
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ST. LUGIE COUNTY, fLORiOA - •
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~ B Y S . . ~ ~
EPUTY LERK '
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