HomeMy WebLinkAbout2740 Declaration of Domicile and Citizensfii . ~ l
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- 4'72bi~2
TO THE CLERK OF THE CIItCU1T COURT.
ST. LUC 1 E Opt~y. ~,pg~~;
This l: my decluation of Domkile and Citisenship in the State of Florida that I am Buns this daT in aooocdanos. and in
contormity with 3eetioo 228.1?. Florida Statutes..
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I was farmer a legal resident of - ~ ~~--~~L ~ ~ I ~r~ ~ ~ ~ and h "
( 1 (Beats)
resided at / ~ • ' ~h ~ _However. I have changed my domicile to ~ _
t8tnet aed Numbarl
and am and have been a bona Bde resident os the State of Florida aince f- ~ ~ r cl day of
C _ ~C. t) S ~ . lp~ and I reside at ~ ~1 ~ ~C~(`--~ ~ ~c7 ~ '
~ l8treet cad Nombeel
~c~c-= _ 1.-_~ l c ~ ~ ST. LUG 1 E count?. Florida, -
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and thi4 statement is to betaken as my decLration of eitisenship. adnal legal residence and domiale in the State of Florida.
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- IF FOR THE PURPOSE OF ENROLLING IF FOR NOMESTEAO PURPOSES
CHILDREN tN SCHOOt.s PLEASE STATE PLEASE CHECK:
THEIR NAMES:
`1 - t9~ JAN 16 PN 2~ 44
" F D ANO RECOROEIlO `
ST~~~CrWOITRASA-
CL CIRCUIT CO
' RECORD \'ERlFIEO 1
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i
I FURTHER CERTIFY that I w~71 register at my Ioea? address when the registration books reopen. and comply with all
other requirements of a legal resident of thu State. .
I F'URT'HER CERTIFY that I h:ve no intention to return tom former domicile. and I intend to remain in
-r- _v ~ UC 1 E ~ County.
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Florida. permanencl;.
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~'X.C"
_ ~ a` f
~ 1 (Name)
Sworn to an ~t'itilfed betore me this day of ~ ~ ~ \ ; ~ ~ K~_ \ ~ , _ ? L/~_ f
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H A.D.1 ~ 1
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ROGER P01 TRAS, CLERK OF C IRGUI f COt~tT
ST. LUG 1 E COUNTY, FLOR 7 DA
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~EPUTY t.ERK ~ -
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