HomeMy WebLinkAbout0076 _ .46.6'75
TO THE CLERK OF THE CIRCUIT COURT.
ST. L UC 1 E COU~y, ~,O~A; .
This is'Eay declaration of Domide and Citizenship in the Stet! of Florida that I am fling this day in aoeordanee. and in
conformity with Section 222.17, Florida Statutes. ,
rr ll ~ .I
I wss former a kgal resident of PI e r G ~ /~~D ?-1 d and I
LL G1 IStatttl
resided at T ~ ~MR,r ~I Q tQ Ql < G+..~ 0 owever. I bave changed my domie~7e to
(Street and umber) ~
and am 4and have been a bona Sde resident of tht State of Florida liner - 1 t day of
~1'`a.~' C' ~ 19 _ and I reside at V'14-~ e s CU 1 0'~~ RC+
lStret and Number)
- p/ e ti C "e. S T. 'LUG 1 E County. Florida.
It~it7l
and this statement is to be taken as my decLntion of dtisenship. r-dual legal residence and domia'le in the State oI Florida.
i
IF fOR THE PURPOSE Of ENROLLING IF FOR HOMESTEAD PURPOSES, '
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKI
THEIR NAMES:
-~AT~_~~ NN ~e c ~
3s'9 CCT -8 tl~ :l~ 3^0
fflltU ANC "-t;urt!_U
3T_t.UCIE CCL"tiY.r
RD6ER P01 i Ri.S
Ct.ERH CIRCUI i C~JRT
~~~.V ! 5
l
~ I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with all
E~ other requirements of a legal resident of this State.
! I FURTHER CERTIFY that I have no intention to return to my former domiule. and I intead to remain in
T. U C I E ,County. 1
(CRS) - ~
t
Florida. permanents; .
(Noma)
(Address)
Sworn to and subsm'bed before me this ~ day of
- cfo b e r --c-~ .
.e.n.19; ~1 ~h ehc~ Coa~~~)
ROGER PO I TRAS, CLERK OF CIRCUIT COURT
ST. LUGIE COUNTY, FLORtOA - -
~ r _
(IR _
tlU1t u~ PAGE