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HomeMy WebLinkAbout1378 • • • . • ~ D~clara~ton of ©om~cile aid C~~iz~~s~ii ~ i 4'7''168 To ~ cl~i;x oF~ c>Ilcurroovli"r. ~ ST. LUG I E ppU~y, FLORIDA: i T6ia is m,T declaration d Domidle and Citizenship in the State d Florida that I am Hung this daT in aacordanoe. and is contormit~ witb Section 22Z.1T. Florida Statutes. I was farmer a iegat resident d ~ - and I _ ~J tdV resided at t~ ~i` - However.Ihavs eLange3 m,T domicile to t8t~st asd Nom0erl and am and have been a bona fide resident d the State d Florida since dag of ~ - ~'~~'V .19~~,. and i reside at f~(/~~~ ~~j~ ~ (8tnet Nomb~ ~ ST. LUGIE ~ and this sbteme~ fs to be taken as ap declaration d citizenship. actual legal residence and domiale is tbe.State at Florida.. ~ • Ii FOR THE PURPOSE Of ENROLLING ~ IF FOR NOMESTEAO PURPOSES, CHILDREN IN SCHOOL, PLEASE STATE Pt.EASE CHECK: THEIR NANE8S _ i~~tl f E~ 29 41 - ~ F1EE0 RI;G R.COKflf 0 d St.EtIC1E COl11ltY.Fl A. ~ RpGER POITRAS • CLERK CiRCUlt C9thZ~~-- , t1'~fi~ I F[JRTNER CERZ7P'Y that I wRl register at m,T local address when the registration bode reopen. and compb with aD other rego>rameata d a legal raside~ d this State. I FURTSEK CERTg'~th~t I have no intention to ratnrn to mF former domicile. and I intend to remain is i!7arsda. permanea~, - L C } U : i 1~ ` 1 iAddrr~) swore to and wbscr~ed betaee me this ~ d~ d_ A.D.19 V,~, - ROGER POITRAS. CLERK ~ CIRCUI T COCd2T ST: LUGIE COUNTY, FLORIDA . BYs c-~e - . _ _ EPUTY LERK - . 8x326 PA~E~.376 1