HomeMy WebLinkAbout2789 b.~ V ~ ` ~ ~ l.a ~ ~ ~ . •~i a ? 1 ~ V t t ~a V ~ ~ l ~ L./ 1 I ~ 1 1 1
• ~~~289
TO THE CLERK OF THE CIRCUIT COURT.
S~. LUG 1 E COUNTY. ~-t.,ORIDw:
~ Thu is my declaration of Domicile and Citizenship in the State of Florida that I am fling this day in accordance. and in
conformity with Section T12.1T. Florida Statutes. n
' I wu formed a legal resident o! ~G rm ~ l~a~~2 _ ( can n and I
, ~ t
resided at /H U tin / c, ~ h ~ _ however. I have changed my domicde to
IStreet and Number) -
and am and have trees a boas fide resident of the State of Florida sine c~ -day os
/1~~L,P,,; bey . ~s 79 _ andlresideat ~90a ~r~ fl C't
13treet and Nnmbed
~Q r f ~ f _ l~.uci e ST . L UG I E County, Florida.
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and this statement u to be taken as my declaration of dtizenship, actual Legal residence and domide 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
s
f1Lc"0 Rhl~ E=CU+.ircD
ST. Lu~iE ccuNTY. ~ ~ a.
ROGER POITRtiS
CLERK CtBCIJli C~ilFT
~_tr,~c~•~r.~~•._
4.'i~289
i I F[JRTHER CERTIFY that I will register at my local address when the registration books reopen, and comply with all
r other requirements of a legal resident of this State.
f
E
I FURTI~R CERTIFY tbat I have ao intention to return to m_v former domic~e. and I intend to remain in
~ T. U C I E County.
~ _ ICkty) -
f')orida, permanenti~.
• couyT~F,~~
1
IAadrea.l
swam to ana snbsrnbcd before me thu ~ nay of
- 1:_- - _
. A.D_ 19.79 .
' r
ROGER POITRAS. CLERK OF C IRGUI T COURT
.
ST. LUG 1 E COUNTY, FLOR 1 OA _ -
• - .
B Y : ,4,,.~~ -
• _ E P UT Y L E R K ~O~X 319 PAGE~776 •