HomeMy WebLinkAbout0427 s
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D~ciara~ion of Dor~icil~ and ~i~i~~n5i~i
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4'77013
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E COUNTY. l-I,pRmA;
This is n41 decLration of Domicile and Citzenship in the State of Florida that I am Sling this dad in scoordance. and in
conformitj with Section 222.17. Florida Statutes.
yo
I eras former a legal resident of ~2G t'~~~ - art ~ ~ ~ I
_ t(lt7) SState) ~
resided at f 'A y / ~S %
- _ However. I bave cbaaged aN domicile to ~
18treat and NamDad
and am and have been a bona Sde resident of the State of Florida since ~ .3 ~1 ~
.
~o Iicn B ~•e- ,19~.~. aad I reside at ~ //'S~ J~ • w ~ /
~Acf ~,5 %
~ c ~ttis.P ~-•F
/ (Steeat aad Nnmbr)
d 2 I s T, oC y G i E ~ ST . l UG I E ~"„L oil,-, a .9- Count. Florida.
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aad this s4tement is to be taken as mT deelantion of citizenship. actual legal residence a~ domicile in the State of Florida.
I i FOR THE PURPOSE Of ENROt.t. LNG I F t'OR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE. CHECK:
THEtR NAMES:
's3
i
130 ~E~ 2~ 11M 1~ t l
4 ~ ti
3
. Sion
~.~~~t
4`7'7013
I FURTHER CER1'II~'Y that I w~71 register at mT local address When-the registration boolu reopen. and compb witb all
other requiresseats of a legal resident of this State.
i
I FURTHER CERTIFY that I bave no intention to return to m~ former domicSe. and I intend to remain is
T U C E Conntj,
(Ck7) .
Florida, permanents; .
t1 ti r.~;? ! J~~~i
. 'f
- ~ ~
. .a ~ a
(Nana)
Swore to and snbsaibed before me this dq! of_ _ _ ,l/ J~ ' ~l' - -Q~~ f
~C/3• . A.D.19~. vim` ' ~ ~~°'Z'`.'4_ 33 ms's
1- ~
ROGER P017RAS, CLERK OF G i RCU 1 T COCdF2T
ST. LUG 1 E COUNTY, f tOR 1 OA •
BY:
EPUTY LERK
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