HomeMy WebLinkAbout0696 ~.1.?Gi C4:il. -VI t.~~.. ~ c .,'vtll: G211U L?illGt.,11~111U .f
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s0 THE CLERK OF THE CIRCUIT COURT.
S~'. LUC 1 E COUNTY, FLORIDw:
,
4'his is my declaration of Domict~e and Citizenship in the State of Florida that I am fling this day in accordance. and in
conformity with~Section 222.17. Florida Statutes. -
' I was formed a legal resident of _ Du ~?n1 E /l o ~I ~ I- l ~ ei 4.g and I
• ~ ~ ICit~) IStala
resided at ~tR 2 ~f • ~ ~:x /I SI/-1- However. I have changed my domicile to
(Street nail Number) .
and am and have been a bona Ede resident of the State of Florida sinct f Sf day of
OR1 ~ 291q andIresideat 1~-~ I .goX ~G9
13cr~.t ana N~b~)
FT - PE ~~c t ST . LUG 1 E County, Flvriaa,
tc~)
and this statement is to be taken as my declaration of citizenship. actual legal residence and domicile in the State of Florida.
iF ftiK TisE PvnPOSE O#' L-~-R^! ! !!!s if fOR HOMESTEAD PURPOSESa
CHILDREN IN SCHOOL,~PLEASE STATE PLEASE CHECK:
THEIR NAMES:
fJ~ED ~M~ : •.•'~tOED
1f1~. LUC?r „ . t FLA.
ROC:: ; ; • t5
NOY ~ i2 30 ~
4'7'724: ll
I:
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I FURTHER CERTIFY that I will rrgister at my local address when the registration books reopen, and comply with all
oilier requirements of a legal resident of thu State.
I FURTHER CERTIFY that I have no intention to return to my former domict~e. and •I intend to remain in
T. U C I E _ County,
_ ICit~) _
F'}orida, permanenti;. ;
s
.;:~:r..~;~~~
v , GG '
1 ~
(Address) s
Sworn to and snbsrn'bed before me this 3 ~ day o! ~Dr~ ~ic,eCF ~/off'/ 3 ~ySU r
- ~ ---9 -
ROGER POITRAS. CLERK OF GfRCUIT GOl~2T t
~ ~ .
1
ST. LUG1E GOUNTY, 1:LOR10A - ~
BY: . • . .r
' _ EPUTY LERK f)~ _
3!17% c~.~ PaGE -
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