HomeMy WebLinkAbout0163 i r tion of Domicile and Citizenshi
Dec a a p
49.5003
TO THE CLERK OF THE CIRCUIT COURT.
ST . LUG 1 E C0UN1~y, FLORIDA:
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This is my declaration of Domic~7e and Citisenship In the State od Florida that 1 am fiUas this day in acoordanoe. and in
oontormity with Sedioa 222.17. Fbrida Statutes.
I was iormerl a legal resident of ~ M 0 ~ ~ ~ _ ~ e a t c ~ a and I
o ((~ty1 1 1
resided at ` ~ ~ ~ ~ \ a - However. I have changed my domide to
tBtrMt sad Number)
and am and have been a bona Sde resident of the State oS Florida since ~ 1+ ~ ~ - C e y e n ~ day of
s` _ 19 and I reside at ~ S ~ /~o tea ~n t S~ t
(Ste+at asd Nmnbe)
t ~ l~; c r p _ _ ST. LUG I E County. Florida,
IGtyl
and this statement is to be taken as my declaration oI citizenship. actual legal residence and domiede in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING If FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
_ _ 1980 Al!~ -4 P~1 ~ b2
fItLC FECORDID
Si. lUC1E t:0tlNi Y. f LA.
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CtRIP~nT ~Si ~ _
- " p ~'ER1FIf 0
495003
~ I FURTHER CERTIFY that I wi71 register at my local address when the registration books reopen. sad comply with a[I
other requirements of a legal resident of this State.
9 I FURTHER ~ CERTII~'Y that I have no intention to return to my former domicile. and I intend to remain in
! -
- JT . ~ U C i E Cou~y;
(C•ityl
~ Florida, permanenu; .
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~ . ~ ~fJ~
_ _ iM. 7 V
.
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Swam to and snbsm'bed before me this day of
h ~
S
_ ROGER I TRAS. CLERK OF G IRGUI T COt~2T .
ST. LUG 1 E COUNTY, f t 1 A ~ -
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BY: ~
r PUTY LERK
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800 c)e)l) PJIGGE . y~
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