HomeMy WebLinkAbout0865 Declaration of Domicile and Citizenship
• ~ 454455
'!00 THE CLERK OF TAE CIRCUIT COURT.
S~•. L UC 1 E OOUNTY. FLORIDA: .
`;!'his is mT dee]arstion d Domidle and Citi:eaship in the State d Fbrida that I am tIIias this dy is aoeordanoe. sad is
_ coafarmit,~ wkh Ssetias 222.17,1:7orida Statutes.
I was iormerl s legal resident aI ~ I j
(Qq! Ibl
resided at However. I have changed mT domidls b
18tr..t and N~e~
aad am and have been a bona fide resident d the State d Fbrida sins 'jam dad d
1l~~, and I reside at f O /~ar..*ifw' ~.7~ /-.u~lr.Gt~ ~ , F
lea..t aed Nasbd
• ST. LUG1E.
Co:mti. Fio:ida, .
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and this statement b b be taken as ~ declaration d dtiseaahip. actual legal residence snd domia'le is the State d Fforids.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOL,. PLEASE STATE PLEASE CHECKt
THEIR NAMES2 •s
:9~ 9 tt'', -9 PN 2 39
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a~i~
- CLERK CIRCUIT T~
RECCnO YERIFIEO t
45455 ~
i I FURTHER CERTIFY that I w:71 regisbr at mT local address when the registration books reopes, and eomplT with aU
other requirements of:legal resident d this State.
i
I F't>ttTAER CERTIFY that I have no intention to return • to mY .former domie~e. and I intend to rem:* in
County.
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Fbrida. peraoanend~
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Swore to and snbsm'bed before me this dsT d ~~~~e~1-GQ~
A.D.19~~I i
R A C ERK OF C IRGUI T GOU2T
1 ~ . •
ST. LUGIE COUNTY, FLORIDA
• .
BY: ,
EPUTY K
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