HomeMy WebLinkAbout2174 i~L:VIGtt c..,~ _ t t,~~.~1~~~..1i1:. Ql1l.! ~ ._1,11J111~J
- 4Ei4924
'FO THE CLERK OF THE CIRCUIT COL KT, -
ST. LUG 1 E COUNTY. FIARIDA:
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 ?22.17. Florida Statutnes~,
' I Was lormerl a legal resident of ,~~~i....(Si ~ ~-h ~ ~ t ~<< ~ - and I
reside3 ai _ No~vever, I have changtd ma domic~7e to
(Suit sad Number)
and am and have been a bona 5de resident of the State of Florida since ~ U ~ day of
19.7 _ and I reside at -/~(D~~ ~ • i'~1U.t V_ ~.~-I'~
~ " (street >md Number) .
- 6"i o1t!C1L~ _ ST. LUC 1 E County,FJorida,
and this statement is to be taken as my declaration of atizenship. actual legal residence and domicile in the Slate of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAHES:
s ~ f 1
3 :;Cf': -5 2. 12
FiLEII A!1£ l+tiur.::.
sr.tue(E ccur; r. ~ t a.
Ro~H (=cart?
f 'C'.'•i i _
4Ei4924
I FURTHER C)1RTIF'Y that I wt~l register at my local address When the ~regi_ttratioa books reopen, and comply with all
other requirements of :legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to my former domiu~e, and I intend to remain in
~ T. L U C I E County.
ICRy) _
g Florida, permanenti,:
_ I _
- _
'
_ .
.~i~~~ (game)
~ ~ ~ ~ (Address) ~ ~ ,
Swam to and snbsmbed before me this day of _ ~
_ ~ ~1
ROGER POI?RAS. CLERK OF CIRCUIT COURT •
. _ = - -
ST. LUGIE COUNTY, FLORIDA - -
•
BY • ~ . -
•
~ EPUTY LERK (IK