HomeMy WebLinkAbout2840 . . . . . . . • t~~~ ' .
I~~ctarafiion of C~on~icil~ and ~iti~e~~ship ;
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TO THE CLERK OF THE CIRCUIT COURT. `
ST. lUC i E CpUNTY. Fi,pRIDA: . . {
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Thts Is m~ declacation of Domic7e and Citiunsbip in the State oi Florida that I s,m Slinr this da~ in aecordance. and in
conformit~ wie6 Section 222.17, F7orida Statutes.
~ I was fo~ a legal resident of 1 O SpJ~~~~'S ~ _ CO L QRj~~c/ ~ and I;
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e s i d e
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t 0~ _ Ho~rever. I have ehanged m?~ domic~e to s:
(8treet and Numbe~ . '
and am aad have been a boaa Sde resident of tbe State of Florlda sinee ~ ~ ds~ d~`~:
! -19~ and I reside at / ~ ~ S~i~ J~//~. C. Q~S T~~~hPO 5
tsU..c.aa Nnmbeel f
~7- P/~C~i ST. LUG 1 E Count~.Florida. '
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and this atatement is to be talcen aa m~ decluation of citizenship. actual legal reaidence and domicile in the State oi F7orids.
IF POR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES~
CHIL~REN IN SCHOOL~ P~EASE STATE PIEASE CHECKS ~
THEIR NAMES:
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~919 J'!L I 8 P~ 2~ ~ 4
Fi~~o pNc k= corw~o ~
s ROGER POITRASA
CLERK ClRCUIT CQ - f.
FCC,iKD ~ER:' iC[? C e
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F
e
j I FURTHER CERTIFY that I w~71 ngister at my local address When the registntion books reopen. and comply with all
~ other requirements of a legd resident oi this State. " ,
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I FIIRTHEft CERTIFY .that I have no intention to return to m~ former domic~e. and I intend to remain in
^ ~ T i u
c"-
i
E~ - Count~.
((%d7) _
Florida. permanen~i;. '
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o~NTY ~o {
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~ • LUCIE ' (Nam~)
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~ Sworn to and subserr'bed before me thi~ dsy oi ~
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A.D.19
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¢ ER AS CLERK OF C IRCUI T COU2T
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ST. LIJG I E COUNTY, FLOR t • , .
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EPUTY LERK pc~~+ ' ~
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K~~~ P~GE~OJrJ . :
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