HomeMy WebLinkAbout2755 Declaration of Domicile-and Citizenship
. ~ ~ 4'70946
TO THE CLERK OF THE CIRC[JIT COURT.
_ ST, LUG 1 E CpUNTY. ~,O~,A;
This o my decoration as Domicile and Citisenship in the State of Florida that I am filing this d~ in aoooedanoa. and Ln [
rnntormity with Section 222.17. Florida StMatutes. ~ ~
I was former a legal resident of J'/~L~GLV~O~ ~ /Y~i~~/`~iE'~'e and I
q (mss) (State) T'
resided at _ OL~~ ~~~C/l1LUOD4t7 /Q~/~~ However. I have ebanged my domicils to
ISenat nail Nambae)
and am nail have been abonafideresident ofthe-State d Florida since G'~D day of 1
~~L` 19~~. and I reside at ~y~' ~-~OSS>~olrt/ %
(Stra.e nail NambK)
ST. LUG I E
(ties) i
and this statement is to be taken as my declaration a[ eitiunship. sctaal legal residence and domia'le in the State oil Flocids.
IF FOR THE PURPOSE OF ENROLLING IF FOR NOMESTEAb PURPOSES,
CH1lOREN 1N SCHOOL, PLEASE STATE Pl•EASE CHECK:
THEIR NAMES2 ~
i9T9 OEC 28 P!I 3: 33
= is g
RDGER
POITR
3A.
- ~ CLERK CIRCUR COURT
RECORD VERIFIED
4'70946
i
I FURTHER CERTIFY that I wilt register at my local address when the registration books reopen. and comply with aU }
other requirements of a legal resident of this State.
I FURTHEc'i CERTIFY that I have no intention to return tom former domicile, and I intend to remain in
- ~ U C 1 E County.
~ C/G J C°i t(ats) .
Florida. permanenti;.
.:r`~! }
• ~~i ~f tit
_ •G~
, " ~ ~ IN 1
- ~
~iyorastoil~~~ptbsedbed before me this day of -
- ~ !
C - . A.D.19~
ROGER POt TRAS, CLERK OF C IRGUI T COURT 0)
1. / €
ST. COUNTY, FLOR1
E P U T Y L E R K 8~ ~'Z PAGE
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