HomeMy WebLinkAbout0058 Declaration of Domicile and Citizenship
494934
TO THE CLERK OF THE CIItCUIT COURT.
ST . LUG 1 E COU~Y, ~,ORIDA; _
_ - .
This is my declaration of Domia'le and Citizenship in the State of Florida that I am filing this day in accordance. and is
conformity with Section 222.17. Florida Statutes.
I was former a lcga) resident of ~CJ ~A / U - W and I
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resided at / A Ric ~ s~ - However. I have ehan my domicile to
IBta~at sad Numbs)
and am and have bean a bona fide resident of the State aI Florida since a ~ ~y ~
C ,19_ ~ / - and I reside at to ~ ~ D S IR~eT
ISteMt sad N®brl
r
% -S 1 ~ ~C ~ _ ST . LUG I E qty, Via,
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and this statement is to be taken as my declaration of atizenship. actual legal reaidetsee and domic~e in-the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
l98f1 AUu •4 AK ii~ 00
_
S tIEO~~IRERNC FE TY
FE A.
~i~~~R TTCRA~
fM tQ
RE.COROl~tRIFtEO t
494934
~ I FURTHER CERTIFY that I wt~l ngiater at my local address when the registration books reopen. sad comply with all
~ other regnirements of a legal resident of this State.
I FURTHER CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
i L. U G I E _ County.
_ ICit~)
Florida, permaaent:i; .
-
(/4ddes~s) j
Sworn to and eilbs$r~bed before me this L~ day of
3 .
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_ ~ y
-ROGER POITRA , CLERK OF CIRCUIT COt~tT
ST . L UG i E COUNTY, f LOR A - -
-
BY: ~
E UTY IERK
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~ ' ~ 800 PUCE
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