HomeMy WebLinkAbout1669 Declaration of Domicile and Citizenship
4`79'70'7
TO THE rLERK OF THE CIRCUIT COURT.
ST . L UC I E COUI,pI•Y, ~,O~A;
This is my declantioa of Domicile and Citizenship in the State of Florida that I am filing this day in accordance. and in
conformity with Section 222.17. Florida Statutes. ,G~
I waa formerly a legal resident of _ ~o t 4 rti S. 4 J ' l ,f o a'', ' and I
lCit71 18tatd
resided at ~ 0 s 1ti~e s-~w. Q v e. However. I have changed my domic~7e to
18creet and Nambal _ -
and am and have been a bona fide resident of the State of Florida since ~-s "r`4 day of
4 19
~U and beside at /Sy ~ 2~'p~r'r ~ -
IStraeR aad Nnmb~)
~fi l~~' e ST . l UC I E aunty. ~
laa~
aad this statement is to be taken sr a4y declaration of citizenship, actual legal e~esidenoe and domia'k in tbs S4te of Florida.
if fOR THE PURPOSE OF ENROLLING If fOR HONESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CNEtKt
THEDIR NAMESS
-,f1 r ,~G n - ~ taw 7"~~-~
_ I~Q NAR t 7 A1~ I I~ 53
. PILEO AI{Cp~~E1CTUit~F`O
- STIitOG~R
PWTRASA.
oLFlal CStCUR CQUIIT /J
IlECORf VERIFIf,O...~ -
4'79'70'7
I FURTHER CERTIFY that I will register at my local address when the registration books reopen, and oomph with ail
other requirements of a legal resided of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
- - UCIE
IGtyl _ • Cry.
Florida. permanenu; . -
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- (Nam)
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S.vorn to and aubsm'bed before me this ` / day a[
L~ ~
ROGER POlTRASs CLERK OF GIRCUI T COC~2T
ST. LUGIE COUNTY, FLORIDA -
f- EPUTY LERK '
•
- 8~~327 P~1~g-..
.4r?r1 Fo-m 11.22