HomeMy WebLinkAbout1045 ' • • • • ~ ~
Dectarat~on of Domicile and Citizenship
481115
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG I E OOUIVTY. FLORIDA:
This is ~ declaration of DomicDe and Citisenship in the State of Florida that I am Kling this day in seoordance, and in
conformity with Section 222.17. Florida Statutes.
I was fob a legal resident of and I
(t2ty1 tStatal
resided at ~ However. I have changed my domicile to
(Str»t aad Noaasar)
and am and have been a bona 5de raaident of the State of Florida since ~ ~ ~ ~ ~y ~
.
19~~and I reside at n--
~ (8tewt and Numbar)
` ~ ST . L UG I E ~ County. Florida.
tdbl
aad this statement is to be taken as my dec4ntion of dtisenship. actual legal residence and domicile in the State of Florida.
_ _ IF FOR THE PURPOSE OF ENROIIING IF FOR HOMESTEAD PURPOSES,
CNIIOREN IN SCNOO~, PLEASE STATE PLEASE CHECKS
THEIR NAMESS
- 19~t1 MAR 27 PM ~ 46
iT
l~tE f''```A'
ROGER p01TRAS
t3.1:RK C!RdIIT COtill
yfitiflEO__.
481115
I FURTHER CERTIFY that I w~71 register at my local address when the ngiatration books reopen. and comply with all
other requirements of a legal resident of this State.
I FURTHER CERTIF9f that I have no intention to return to my f
rmer~~. and I intend to remain in
S T . LUG 1 E _ County.
(airy)
Florida. permanent3; .
~OUI~Ty -
~ ~ ~ ~ J
~ : ~ 9i ~ ~.~~-1 GRIM ~
cca++ir• ~T. ~i
~e2ce
f _ IAddrsnl
Sworn to and subsrn'bed before me this a 7 dsy of
~y~
O / l ~ . A.D. i~'~ ~ 2 R 6e!-`j l.. Ail b e R l So n/
ROGER POI TRAS. GLERK OF CIRCUIT COC~2T
ST. LUGIE COUNTY, FLORi~A
~ BY:
f .
EPUTY t.ERK -
8~~328 P,~E1045
~ 'AGn Fnrm Tt-'~