HomeMy WebLinkAbout0448 •
F r-
itt
• . • • t
Dectaratton of Domtctte and Ctttzenshtp
4'71363
TO THE CLERK OF THE CIRCUIT COURT. {
ST. LUC i E - ~ COUNTY. FLORIDA:
Thin L ~ declaration of DomicDe and Citizenship in the State at Florida that I am Sliaa this da,T in aoooedaooe. aad in
conformity Mite section 222.17. Florida sat/ute..
I was f
~ a legal resident of L~ X , /C~C~ Tn n~ ~ a,d I
/ lQt,l ce~w
resided at J
~o~ f'i ~~,1 Q JrD /1 ~ _ However. I have eeansed mT domia'k to -
(str..e.od Nmab~r) .
and am and have been a bona fide resident of tee Sbte of Fbrida linos ~ ~ D day of ,
C TC~ f'S~-Q ,19~ and I reside at 1 / l 7 .S . OC FA~
/e
~C ~ ST. LUC 1 Esa~.c..aNmtie.~l
1 f ~ ~t ConntT. Florida.
and this statement is to be taken as my declaration of eitisenship. actual legal naidenoe and domia7e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSESa
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: .
r--
19$0 J1lK -3 AN ~ 25
R06~CPOIT~AS
A.
CLERK CIRCtI1T T
RECORO YER1FtE0
4'71363
I FURTHER CERTII~`Y that I Mr7l register at m~ local address when the registration books reopen. and comply with all
other requirements of a legal resident of this S4te.
I FURTHER CERTIFY that I have no intention to return tom former domirrle, and I intend to remain in
- - - s - - - U t 1 E .County.
(City) - - - :
Florida. permanensl; .
.rte....... ~
UC ~ (Name 1
Sworn to and subsrnbed before me this ~ day of ' ~ ~ <<- , f ~ ! C~J R =
75' ySZ)
A.D.18~
R P01 TRAS LERK OF C IRCUI T COtdFtT
ST. LUGIE COUNTY, FLORID
BY: . .
EPUTY LERK
- - g~323 Pa~E 448