HomeMy WebLinkAbout0630 Declaration of Domicile and Citizenship
46 X929
TO THE CLERK OF THE CDiCUIT COURT,
ST. LUG i E COUNTY. FLORIDA:
This is my decLration of Domic~e and Citiseasbip in the State of Florida that I am fling this day in sccordanoe. and in
conformit; with Section 222.17. Fbrida Statutes. /
'I was ion a iaRai nssweni vi ~ G T's • ! P » P ~S' e I
(Qty letate)
resided at ~ ~ ~ v Vf~
~ ~i - However. I have changed mT domicde to
18teeat and ~~i
and am and have been a bona Ede resident of the State of Florida since d+~7? ~
.19!
- and I reside at ~ ~ i~ 'S~
13tsMt asd Numbr)
,to~ .S~ . v ~ ~ _ ST . L UG I E County, Florida.
(ati)
and this statement is to be Laken as my declaration of citizenship. actual kgat residence and domieHe in the State ~ Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
~;C cl e / ~Nnn ~Tya~N~
?9 Q~T 2G r~::~ 48
r~tEL' Lhi i'tC~silcU
SLLUC!E CGUNTY.FLA.
R06ER POITRAS
CLERK CIRCCIT C~!:RT
E'fuROt'F"~iIF~:~ -
• 453929
I FURTHER CERTIFY that I X71 register at my local address when the registration books reopen. and comply with all
other regniremeats of a legal resident of this State.
j I FURTHER CERTIFY that I have no intention to return tom former domiu7e. sad I intend to remain in
U C 1 E ~ County.
((qty) _ .
~ Florida, permanencl; .
~c-~: ~.G
r ~ c... • t~ A (N
Sworn to and
~sn~efore me thi: S ds, of ~ (~-c_e _ .
Ocfob~,^ - .
~ . A.D.19
~ 7 /
ROGER POI TRAS. CLERK OF CIRCUIT COURT
ST. LUG I E COUNTY, fLOR 1DA
EPUTY IERK
- ~
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