HomeMy WebLinkAbout1166 ~~:~:iara~ion c~ t~omicile~ and ~:._:_L:.~:. t:
468015
TO THE CLERK OF THE CIRCUIT COURT
ST . LUG 1 E COU~Y, ~„O~A;
This is my declaration of Domic~e aad Citiseaship is the State of Fbrida that I am 51iag this day in accordance. and is
conformity witb Section 222.17, Florida Statutes.
I was formerly a legal resident of ~0.c~.:k.~A.~~h1 , ~'i,ti~s-~l~N.i? a and I
(City) IStatd
resided at y a o `i w v o tit, q~, p A.~ L . . However. I have changed my domicile to
l8trat sad Namt+ar).
and am and have been a bona fide resident of the State of Florida since ` 5 T day of
c.zN.~z2 .19~1~
-andIraideat ~-~r•NZA S~2t~~-
(8trrtand Nnmbar) '
c~.~ 5--~. ST . LUG I E County. Florida,
_ Icy)
and this statement is to be taken as my deelaratioa of citizenship. actual legal residence and doi:.icile in the State a[ Florida.
IF FOR THE PURPOSE OP ENRO!lING IF FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMES:
fllEU ANi• ~ .•.~E~
R~+~ = ' S
CtE=.. . ' t'!!R
REC, ~ - `
~ `
OEC 3 3 is P~
-
468015 I'
I FURTHER CERTIFY that I wt71 register at my local address when the registration books reopen, and comply with atl
other requirements of a legal resident of this State.
I FURTHER CERTIFY that I have ao intention to return tom former domicile, and I intend to remain in
as•e~~~. U C I E .County.
Katy) ~
Florida. permanentl; .
G~UNTy I
•`'FCCUr:tr•t` c~`c~~~ G--:NZA S-t-nt~~- I
^ (Adder)
swore to and subevibed before me this 3 d:j of Cc~_~ S~ - 1., .J. ti 2: ~ i1
ryQ
2 c E M r . A.h~.19_ / / ~ ~M oTh 7 r` . 7v R N t le)
ROGER PO I TRAS, CLERK OF C IRGUI T COURT
ST. LUGtE COUNTY, FLORtoa
8Y: A _ ~
EPUTY JERK
8~~ 321 P,~ 1165 f