HomeMy WebLinkAbout0883 Declaration of Domicile and Citizenship
495480
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TO THE CLERK OF TAE CIRCUIT COURT.
ST. LUG 1 E COUNTY, r-I,p~~: }
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This is m, declaration as Domie~le and Citisenship in the State of Florida that I am 51iag this dq in aooadanoe. and is
ooniarmitT with Section 712.17. Florida Statutes.
I was former a legal resident of / ~ ~ 'e - and I .
1 lck,) ~Stat.)
:'e~idea ~ ARS q L ~ A y ~ -However. I have changed mT domiea`le to
Iea..c sad Namb~d
and am and have been a bow Sde resident of the State os Florida since ~
~ - daT as
19~_. and I reside i?t ~~~1 ~a a ~ ~ ~ ~
(St»K sad Nambt)
lL~~ _ ST . L UG I E CovntT. Florida.
lC~bl
and this statement is to be taken as mT declaration of eitisenship. actual legal residence and domia7e in the State d Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR NOMESTEAD~ PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS
=.~'1aa~A PaRI~~
_ L f~DA - n P,~RI~~e ~ . ~ Aug -t ~ ~ o ~
[,-~?n(~.i~e ef' ~ Q/~/PN-P ~ ST EOIECOINITY~.E44A.
~p~ER POITRAS
CLERK CIRCUIT C - T
' RECORO ~'ER6~E0 J
- 495480
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j I FURTHER CERTIFY that I will register at m~ local address when the registration books reopen. and eompl~ with all
other requirements of a legal resident of this State.
f
I F[1RTI~A ~CERTI>`R that I have no intention to return to my former domicile. and I -intend to remain in
=--sue-~, , . v _ ~ . ~ v ~ ~ ~ - Countl.
_ ((Std)
Florid:. permanenu; . ~ ~
I
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Y; : 8~'41fn tO ~Dd stiboerbed before me this daY 01~ ~ - Gib
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` ~ ~r. ' .S AS CLERK OF CIRCUIT COtdRT _
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ST. LUGIE COUNTY, FLORiD ~ .
1
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EPUTY LERK
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8336 P~ ~1 ~ ~ i
Sin F<•-T. 7~ ~
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