HomeMy WebLinkAbout0863 ' n of Domicile and Citizenshi
Deciaratio p
495463
TO THE CLERK OF THE CIRCUIT COURT. .
ST. LUG I E Cpt~y, FLORIDA:
This is ~ declaration of Domid7e and Citizenship in the State of Florida that I am filing this daT in aooordanoe. and in
oontormit~ with Section 222.17. Fbrida Statutes.
I was formed a legal resident of ~'Q f ~~l~P N - ~ e ~ yo r ~ and I
1(~it~l t
resided at ~ / cl - Howeves. I have changed my domic7e to
(Street and Nambar)
and am and have been a bona fide resident of the State oaf Floridasince ~ ~7 ~
~ _ ~o b e ~ 19 7y _ and I reside at ~o S~ D~ ~°a h a~P r ~8/a~'~~ ~7~~os'
- ~ 18a.at.ad Namb~d
~'D r T I e%t• G~ _ ST . LUG I E Co~,nt7, Flar;d,,
Ill
and this statement is to be taken as m~ declaration of otiunship. actual legal residence and domidk in the State of Fbrida.
if FOR THE PURPOSE O!< ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
1980 AUG •t I11111~ 17
CLERK CIRCWT COURT
RECORO VERIFIED
49S4S3
I'~ I FURTHER CERTIFY that I wdl register st m~ local address when the registration books reopen, and oomph with all
other requireme~s of a legal resident of this State.
i
I FURTHER -CERTIFY that I have no intention to return to my former domicile. and I -intend to remain in
JT~~L u c ~ E CountT,
'I 1(tit~)
f
Florida. permanenti; .
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r~;
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~~r INaaN)
r~~
(Addear)
Sworn to sad sobsenbed before me this ~ dsT of
A.D.1 -
ROGER P0ITRAS, CLERK OF CIRCUIT GOt~2T .
~ ST. LUGIE COUNTY, fLOR10A
' i
EPUTY LERK
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