HomeMy WebLinkAbout1053 f
.is
Declaration of Domicile and ~itizenshi ~
p ~
4'79323
TO THE CLERK OF THE CIRCUIT COURT.
S~• /~c~c.e. COUNTY. FLORIDA:
This is my dectaration of Domicile and Citisenship in the State o! Florida that I am tiling this day in aceordanoe. and is
conformity with Section 222.17. Florida Statutes. .
I was formerly a legal resident of s~' ~ S C0 ~
n~TI • and I
ICityl Istat+l
resided at N/SS is~ri n 9 O'aKs D~ . However. I have changed my domicile to
18trset sad Numbrl
-EL
and am and have been a bona 5de resident of the State of Fbrida since aZ day at
~a r~ a r ct • 19 ~ " ' and I reside at ~~y 4c f c7 asi ~~~Sf
~~uS ~ 1
a~~ ~~d ~
ISt»d sad NumDsr)
~a t ~ S ~ • ~ u~C [e ~ 5 L~ • /~.t,C ~ e County. F{orida.
t(om)
and this statement is to be taken as my declaration of eitizeaship, actual legal residence and domicile in the State of Fbrida.
l980 LIAR 13 AM il~ 1 I
ST~LUCA
CO
MTY~f
ROG~R POITRA~
d.ERK L'lRgJIT_r~~ .
RCCei10 VERtftfC
4`79323
I FURTHER CERTIFY that I wtll register at my local address when the registration books reopen. aad comply with all
other requirements of a legal resident of this State. .
I FURTHER CERTIFY that I have no intention to return to my former domicile, and I intend to remain in
~ r ~ S~ • ~t.t.L! _ 5~• ~ wC re County.
ICityi
Florida, permanently.
INams)
Sworo to and subscn'bed before me this J d,y of ~ r C SG . F/~• %3 3 ~~.Z
' A.D.19 a ~ ' Q u
f
Noesey Public aw. d Florida at ti.R.
r:,. ~ _ _
. -
My Comtmssion ezpi,res 6:.. . J - - _
ITo be aatcuted in duplicate and origiwl filed with Clerk Circuit Court, anted duplicate with ?at Assessor)