HomeMy WebLinkAbout1428 • . • ~
~~clarat~on of Dor~ic~le and C~tizensh~p
4414439
TO THE CLERK OF THE CIRCUIT COURT.
ST . L UG I E COUNTY, FLORIDA:
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in accordance, and in
conformity with Section 222.17. Florida~Statutes.
I was formerl a legal resident of Sa ~N - ~ I
ICityl (state)
resided at ~ ~3 11l ~ . However. I have changed my domicile to
(street and NumEer)
and am and have been a bona Gde resident of the State of Florida siace ~ ~ _ ~ J ~ ~y ~
19 - and I reside at ~ 7~~ 1/ ~ p
(street and Nnmber)
V ~ ST . L UG I E County. Florida.
lCity)
and this statement is to be taken a, my declaration of citizenship, actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES!
.C/A
- - - .-~9 0~"t 31 w: C3
V
FILEC pNl` 4~ ~(It~iic
ST.LUCIE CC`JYiY.f:...
RCG~R i CI i RA5
CIERKCiRC'J!1 C~:'J~.`
PEA^'`~ cif?. ~ ~ i~l-~-
464439
i I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
j t_ u c ~ E .County.
. (Cit~l .
Florida, permanenti;.
I
'J f ` ~
1 T
'r: ; I
it'~.. 1i:° (Addreea ~ t
sworn to and~sn'`ba~e`r?'bed before me this `31 aay of
b e ~ . A.D.19., 79 ~ ~ ; n d A O1~1 eR
-
~ ROGER POfTRAS. CLERK OF CIRCUIT~COURT
ST. LUG I E COUNTY, fLOR 1 OA ,
9Y: - ~
t'
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