HomeMy WebLinkAbout0156 Declaration of Domicile and Citizenship c~
4`7880'7
TO THE CLERK OF THE CIRCUIT COURT.
ST. L UG I E COUNTY. FLORIDA:
This is my declaration of Domicile and CItisenship in the state of Florida flat I am filing this day in accordance. and in
conformity with section 222.17. Florida Statutes.
I was formerly a legal resident of ~~Q S TX C~^°~ and I
1(~ty) 18tatd
resided at ~ / I Z !/a - fi Cds'J cz
rz~_ _ Howsver. I have ebanged ear domicile to
18wa and Nosb~
and am aad have been a bona fide resident of the state of Florida since h ~~E' t~ day of
~P ~~-se~nr~ ,19 ~
v ' and I reside at _ ~ ~ Tiffin Qom./l« f~v~-
( ud NomDsr)
rf 5 f ~ ~c. c_ , ST. LUC I E County. Florida.
lave
and this statement is to be taken as aq decLration of eiti:eaship. actual legal residence and domIa7e is the State of Fbrida.
.
I F FOR THE PURPOSE OF ENROIt. LNG I ~ FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE P EASE CHECK:
~ THEIR NAMES: ~ ~
t9~ MAR ~ ~ P~ 2` I 1
g . UCIERC
aC . ~A.
. COINS
#R~q VE1Uf tE0
4'78807
I FURTHER CERTIFY that I wNl register at my local address when the registration boob reopen, and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTQ~'Y that I have no intention to return to my former domiede. and I intend to n_maia is
~ - Count
k ((sky)
Florida. permanenr3; .
i
i
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i _ ~ ~ _ i'!d-/'1 CL~ Cc'_ !~C
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Swore~o and subacs!!~d before me this ~ day of ~ r`~ ~t G ' c
C r ~ l11 O
ROGER POITRAS. CLERK OF CIRCUI ~ COt~2T
ST ._LUGIE COUNTY, FLORIDA
I ~ - .
8Ys ~
n ~
r EP ERK
832? P~~E X55 M~
AGn Form 71
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