HomeMy WebLinkAbout1172 Declaration of Domicile and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT.
t
ST . LUG 1 E COUNTY. FLORIDA:
_ .
This is my declaration of Domiet7e and Citiuaship in the State d Florida flat I am Ring this day in accordance. and in
conformity with Section 222.17. Fbrida S4tutes. o
I was formerly a kgal resident of _ ` o~~~~n and I
resided at ~ • ~ X~ ` - However I have changed my domicile to
18trMt and Nambar)
and am and have been a bona fide resident d the State d Florida since ~y d
_ 19' °
v • and I reside at ~ ~ ~ ~ `~`C ~ T~ CQ`-~
` tStnat and N~barl
r(~ C ~ c~ . ~ ~ ?~O _ S T . l UC I E County. is
larida.
Itxty)
and this statement is to be taken as my decLration d citizenship. actual kgal residence and domict7e in the State d Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HO.NESTEAD PURPOSES
CHILDREN IN SCHOOLr PLEASE STATE PLEASE CHECK:
THEIR NAMESt
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~ 31 {
1980 AUG _8 ~
~LED.A~ FE~pRp~~
~OINOTY.F~~_ ,
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TR~gI~$r ~
QC••wn~ ~r' 1 ~
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G I FURTHER CERTIFY that I wi71 register at my lout address when the registration books reopen, and comply with all
other requirements of a kgal resident of this State.
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! I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
U C 1 E _ County.
~ _ (City)
Florida. permanenti; .
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• Sworn to and snbscn'bed before me this ~ day of ~('1~ ~ 1 \ ~C~~ ~ ~
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ROGER POITRAS. CLERK OF CIRCUIT COCdRT
.
ST. LUG I E COUNTY FLOR t OA - -
~ BY:
. EPUTY LERK (j{i ~
• _ BRIM P'~.G~f
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G n F', ' 1 ~
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