HomeMy WebLinkAbout2015 - ' ,.f ' / :
Deciaration of Domicile and Citizenship
~
. 1
a
s
. _ 45152'7 I
~
To~ c~uc o~~ cu~curroovKr.
ST. LuG 1 E c~ovrrr~t. ~.oxxIDw: . 4
Tbis~ is m~r declaration ot Domicil~ and atistas~p io tbe 8tatt ot F1o~ida tbat I sm IDtna tuis da~ in aooocdaaos. and is
~oafonait~ wit6 Seetioa 22Z.17. ~'loeida Statutes. ~
~ I was farme a legal ' at o~ k C~ e 1,~ ~O ~C aod I
IQI~I 18~a~d
rbaided st o1 ~ C G?y C e Q V e _ However. I have ehae~ed ~ domieiie b
l8t~wt ~d I~
and sm and bave been a bona fids resideat atlhe 8tate a[ Fbrida anee ds~ at
. ~ 4 N~ ~ 19~ and I rs~ids at ~a U ~ 7,ON 'Q U e
r (~rMt ed IirsD~t)
Q~{ T S T~ J~ u c i t _ ST. LUG I E ~ounb, ~ids,
IC141 j
snd this atatement L to be taken as m~ deelaration ai dtisenship. aetwt legal residenoe and domk~'le in the 8iate d Ffarida. t
IF iOR THE PURPOSE Oi ENROLLING Ii FOR HOMESTEAD PURPOSESi
CNII~REN IN StHOOL~ PLEASE STATE PLEASE CHECK:
THEIR NAMES.
4
i
i
+9T9 JU? I3 PF 2~ 0I `
FILfO AHO kCCUrUtU
ST.IUCIE CCUNIY.FLA.
ROGER POITRAS
CLERK C~RC:Jt~`C~:?~~
FFCG?D Y~R!=~~•
45152'~
,
~
~ I FvR1'HFR CERTIFY tbat I w~l register st my loeal addnss whea tLe registntion books reopen. and oompl~ witb all
~ ot~er requinments at a legal reaident at thls SLte.
~
~ I F~JRTHER CERTIF'Y that I l~ave no inteAtion to return to m~ former domic~e. aod I intend to nmain in
~ v~. w v ~ i~ CiOUDty
~ - ltS~71 . •
F7orida~ permanenti; .
co~"r~
_ ~
_ ` ^
:s~~
~ j ~ ~?W ~jv
(t S '
v 3~ , ' L~i/
~ •f`~. •'•'~'E J ~ ~Ey+, ~
O~ ' G / _
~ ~JR~~~L~~ ~~TUN~~ / 1 I/ ~
~ ? ) . ~ :
1 dR7- ~ iedd,w~~.l C~~ 1
~ Swaco to and snbsrn'bed before me this da~ o~
~ ~ + • f - i
A.D.19_ ~ _
~
~ R A K OF C IRCUI T COU2T , .
ST. LUGIE COUNTY, F A -
BY: , ;
EPUTY LERK - '
~ ~1'~c312 e~cE'2013 -
~ . ~ ~
f~-T'; r
- ~ ~
r_s._ , _ - - - - -