HomeMy WebLinkAbout0052 Declaration of Domicile and Citizenship
496'780
TO THE CLERK OF THE CIItCtJIT COURT.
ST. LUC I E COUNTY. FLORIDA:
This is my declaration of DomieDe sad Citisenship in the State of Florida flat I am Sling this day in sooosdanoe. and in
auuiwuuit" ~~i~ ~ 1~~ S1`..:.1~ AvTN.1R.
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I was fonaerl a kgal resident of ~ I
tCtty) 1
resided at However. I bave changed my domie~7e to .
IBt»st asd NamDR)
and am and have bees a bona 5de resident of the State of Fbrida since ~ ~7 ~
19~ and I reside at ~ 1 W
~ ST . lUC I E~ ~ Nomt~ Cou~y, Florida.
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and this statement is to be taken as my decLration of citizenship. actual kgal residence and domidle is the State of Florida.
IF FOR THE PURPOSE Oi ENROLLING IF FOR HOMESTEAD PURPOSES,
CHIt.OREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~ '
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THEIR NAMES: - i
190 A!!G ~0 AN 9~ t
I I ~~E' 1, ~?~t~~/l'I /~7J ~ M /RIFE FIIEO RhD FECOROCD
ST.LUCIE CWNITTY.fLA.
ROQER POITRAS
-CLERK CIRCUIT C T
pFCCe~ ~~Fa1r1Ed.__
496'780
I FURTHER CERTII~9t that I w~71 register at my local address when the registration boob reopen. and ~mPl! witb all
~ other requirements of a kgal resident of this State.
I 1`'[JRTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
- - _ U C 1 E . Count.
~ _ (Cxt~l
Florida. permaneaci; .
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Sworn to and snbsen~befors me this 19 day of
ROGER POI TRAS. CLERK OF CIRCUIT CQCdI2T
ST. LUC i E COUNTY, FLOR 1 OA
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- - BY: ~
EPUtY LERK
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- _ - ~
a3~7 PEE 52 ~ - -~;~J