HomeMy WebLinkAbout1173 Declaration of Domicile and Citizenship ~
• 4~.~655
TO THE CLERK OF TILE CIItCUIT COURT.
ST . L UG I E COVIVTY, FLORIDA:
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This is mT decLration of Domica~e and Citizenship in the State of Florida that I am filing this dq in aooordanoe. and in
oontormitT with Section 2?1.17. Florida Statutes. = _-1
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I was formed ale resident and I
-_s t~ lCit~) 1&at~1
resided at owever. I ve changed m~ domic~7e to
(t3treet sad Nmataer)
and am snd have n a bona fide resident of the State of Florida ~7 ~
o v~ ~
' 19~and I reside at ~ ~
- - / (Stmt sad Na®bar)
/ `1~;~ Q . _ ST . LUG I E Co~unt~. Florid,,
cat,)
and this statement is to be taken as m~ declaration of citizenship. actual kgal residence and domie~ in the State o[ Fkridt.
I IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSESs
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: '
~ 495655
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1980 AU6 -8 P!! 2~ 37
I STu ~E1tCC FE T~QE A.
R R P~TRA?St
CLE RCUIT COURT ~ 1
RECCRD VERII'tE0 _
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I~
E I FURTHER CERTIFY that I wi11 register at mT local address when the registration boobs reopen, and oomplT with all
other requirements of a legal resident of this State.
i
l I FURTHER CERTIFY that I have no intention to ret~lrn to my former domicile. and I intend to remain in
7. U C I E _ Count.
_ (Ciq)
~ Florida. permanenti; .
R
_ r~' : - : 'S
iir'. •''Zw
.;~ti
f~,` h`
~ ' (Name)
- _ , i
- Sworn to and subscribed before me this dad of
~
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ROGER POiTRAS. GLERK OF G IRGUI T COCd2T .
ST. LUGIE COUNTY, FLORIDA - -
.
- - BY : Q.+ s
EPUTY t.ERK
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~r,n F~..T.
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