HomeMy WebLinkAbout1488 omicile and CitiZenshi •
Declara r`ion of D p
464484
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E COU~Y, ~,O~DA;
This is my declaration of Domicile and Citizenship in the State of Florida that I am filing this day in aocordanoe. and in
conformity with Section 2?1.17, Florida Statutes.
- I was i"ormerl a legal resident of and I
l y) Istatel
resided at ! K'`i'r`'~"•~- - - . However. I have changed my domicile to
!Street and Number) `
and am and have been a bona fide resident of the State of Florida since day of
~ / , ,3' ~
C~%'~Ci~ ' ~ .19~. and I reside at !I ~ 7~ r.~~ cJ eC~
(Street wad Number)
S~ c S T. L UG I E County. Florida.
t(xt~l _
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
i
IF FOR THE PURPOSE OF ENROIIING IF FOR HOMESTEAD PURPOSES,
CHIIOREN IN SCHOOt., PLEASE STATE PLEASE CHECK:
THEtR NAMES"
s~tt i N ~~co~l ~ ~L ~ ASS ~ ~
1~-9 ~~t 31 2~ 55
s RpG~
R POITPl:S~
CLEFKCIRCUlT CCI:~~
f.::Lf~~q':ci•'1.''.
464484 .
' I FURTHER CERTIFY that I wi71 register at my local address when the registration books reopen. and comply with all
other requirements of a legal resident of this State.
i
E I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
I U C I E ,County.
Florida, permanenti~ . i
f
CO UNry ? ~ 11.J C ~ 1s
c~
_ ~ ~~G
~f'~:._~~ (Name)
Sworn to before me this 3 ~ day of ' ' / e~eC~. ~ •
~~d! . A.D.19_ ~ 5R E ~~R
79 _ ; .
ROGER , PO f TRAS, CLERK OF G I RGU I T COURT - ~
ST. LUC 1 E COUNTY, f LOR 1 OA _ - • 4t ~ -
- _r ' - t
~ a~~~K 319 PbcE 1485 ~