HomeMy WebLinkAbout0902 Declaration of Domicile and Citizenship
495493
TO THE CLERK OF THE CIItCUIT COURT.
ST. LUG I E COU~y, FLORIDA;
_
This o my decoration of DomIeils and Citisanahip in the State of F7arida that I am Sling this day in aeoordanoe. and in
conformity with Section 222.17. Florida Statutes.
1 was formerl a kgal resident of ~oe Ni . ~ 4 /~Q.. and I
(C•it7) 18tatd
resided at ~ 3 2 ~ ~ilZ,~'A H Y. _ However. I have ehaaged my domia7a to
18tr,M..aa NumD~)
and am and have peen a bona bde resident os the State of Fbrida sins ~ ~y ~
~ S ~ .19 Q V ' and I reside at 9 ~ 6 ~ ~C (.°a i~ ~~1~`~. ~ ~ 7 O ~o
ISt:wt asd NambRl
~ ST . L UG I E County. Florid,,
ICUyI
and this statement is to be taken as my decoration of eitisenship, actual kgal residence and domieSe in the State d F`larida.
If fOR THE PURPOSE Oi ENROLLING IF iOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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199o AUG -7 P!I 2 0 t
-
FILEO AEEN~~C F~CORpfO
S R06ER P~WTRAS A~
CLERK CIRCUIT C ~ _
RECORD YERIFIEO
- 495493
I FURTHER CERTII~'Y that I wr11 register at my local address when the registration books reopen. and comply witb.all
other requirements of a legal resident of this State.
I
I
i I FURTHER -CERTIFY that I have no intention to return to my former
d~
o~ ic~7e, and I intend to remain in
,T . L u ~ ~ t _ County.
_ (Cit71
E
t Florida. permanensi; .
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swam to and snbsaibed before me this ~ day of
A.D.1- o -
.
_ ROGER P01 TRAS. CLERK OF CIRCUIT COtdItT
ST. LUG I E COUNTY, f LOR t OA - - -
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~ BY: ~
EPUTY LERK
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