HomeMy WebLinkAbout2705 ~~C~c~~'u~.I~CI (3f ~Q~1~iiCi~~ ~~tC~ ~~^:~Lti_t;i`t5t ti. ~
'FO THE CLERK OF THE CIRCUIT COURT. ~ 4~~
S~'. L UC i E COUNTY, ~-ipRmA;
This is my declaration of Aomic~e and Citizenship in the State of Florida that I am filing this day in acoordanae, and In
_ conformity with Section ?22.17. Florida Statutes.
I was formerl? a IEaal resident of
~d~ ~ A Nt A~ i~ ~ and I
~~p 1(sty) Q.~~~ ~ tStatd
resided at ~A~ ' CTQ ~ d t
s ~ ~n~~-1 O~ ~ ~Q_ t~c~ However. I have
changed my domic9e to
(st,~ret ana N bet) -
and am and have bees a lwna Sde resident oitbe Stste oiFlorida since ~ ~ day of
_ ~ R\ L •,19_L1..., and I reside at ~ ~ ~ y 3~1' M-~~-~1 C~..4.. ~
(3treet tad Namber)
YBGLT ^~T • I~.`~,tc ~ .S ST. LUG f E ~
County. Florida, [
. ((Std) i
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile iD the State of Florida. ±
IF FOR 7HE PURPOSE OF ENROLL ING - If FOR HOMESTEAD PURPOSES,
tHIIDREN IN SCHOOI,~ PLEASE STATE _ PLEASE CHECKS ~ 3 .
7HE) R NAMES. ~ ~
y
~~~a.R~
. [9t9 AUG 20 FI! 2.05 -
. ~T EO a +~ECpt~O
R F p j~~~A-
. - ~~~r ~
• ~CORO YERIfIEO
I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with :11
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicHe. and I intend to remain in
T. U C I E ~ County,
_ {City) .
:'lorida. permaneo?.i;. •
o~Nrr _
j ~;9~ ~
d ; ~N
J~
(Address)
Sworn to and si~bsrn'bed before me this ~ day of ~ ~aT ~Jlrt C L~
_
79 ~ _
I P -
ROGER PO! Si CLERK OF CIRCUIT COURT
1 : ~ • •
ST. LUG 1 E COUNTY, f LOR t OA
t3Y: ~
E P U T Y L E R K ~~Q'
. 8Q~x314 PAQE~?V~7E7 ~ . _ -
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