HomeMy WebLinkAbout1376 Declaration of Domicile and Citizenship
495'x'73 ~I
TO THE CLERK OF THE CIItCUIT COURT. .
ST . L UG I E COUNTY, FLORIDA:
- - -
This is my declaration of Domic~e and Citizenship in the State of Florida that I am filing thin day in accordance. and in
coniozmity ~ritb Section 271.1?. Fbrida Statutes.
I was former] a legal resident of ~dr~ • V C 1 'P F L, r1Q 1 ~ and I
ICtty) 19cw1
resided at y y ~i,~r~? ) ~-t [1 ~ ~ N £i ~ ~ _However. I have cbaaged my domie~7e to
18trMR sad Nombrl
and am and have been a bona fide resident of the State d Florida since ~ ' ~ ' ~ U r l rS day d `
~~R - .19~.L2~ and I reside at N ~ ~ ~ N `f ~~,'P h ~ ~ ~ -
- 18u~..e sad Nnmb~rl
r ~ ~ - y L? t -P _ ST . l UG I E County. FJarida,
1Clty?
and this statement is to be taken as my deelantion d citizenship. actual legal residence and domicile in the Static d Florida.
IF FOR THE PURPOSE Oi ENROLLING IF fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: I~-~I
THEIR NAMES: 1
m, ~ r ~ R P ~ ~ ~ ~ rC~
~r 19~ AUG i i ~ 44
E
. FILED>:ND F~CORDEO
SLLUCIE COUNtY.F~A. I
ROGER POITRA
CLERK CIRCUIT CO jO ,
RECORO YERIFIEO 1
- 495'T73 .
I FURTHER CERTIFY that I w>171 register at my local address when the registration books reopen. and comply with all
other requirements d a legal resident of this State. .
~ I FURTHER -CERTIFY that I have no intention to return tom former domicile. and I intend to remain in
f y
~ . ~ v ~ ~ . County.
_ (Ctty)
{ Florida. permanenci; .
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IN.m.)
(Adde••~l
Sworn to and snbserebed before me this day of
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R GER POI AS CLERK OF G IRGUI T COOT
ST. L E COUNTY, f LOR 1 DA ~ -
~ - - BY, . ~ ~ " ~
• -
. EPUTY LERK
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