HomeMy WebLinkAbout0107 tion of Domicile and Citizenshi •
Declara p
496815
TO THE CLERK OF THE CIRCUIT COURT. .
ST, BUG 1 E apv~y, ~O~A;
This is m7 declaration of Domiet7e and Citisenship in the State of Fbrida that I am ~ this dtq in aooordanoe. and in
eonformit~ with Section 222.17. Florida//Statutes.
I was former s legal resident of r.C Cho ~~o 'r~h~flr~SA tcf and I ,
ICty) 1~1
resided at ~L,~N~-~A ~$n~~'t._ - However. I have changed mF domic~e t,o
1 ~sd Numb~t)
and am and have been a bona Sde resident of the State os 1:7orida siaoe ~
~ _a-f ~ ~ ~7 ~ f
~ 19 AU 'and 1 reside at 6~ ~a ' f~ /fi~D~A~ ~r,(~ l~J•yl'
18ae+t ~sd Namb~r)
/~Et~E ST. LUG 1 E C~nh. Floo'id~
lav) '
and this statement is to be taken as m, decLration of eltisenshi~. adnal legal residence and domicile in the State a[ Florida. -
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
~„~~EJlG!!i E /S~Fi?~E y
_ ~ T•ye~/ ,Coca-.4.vn~ ~~LEx 1960 AUG 20 1!!1 26 - -
FILED Ati~ FECOAOFO I
ST. LUCIE 660UN~ Y. F t A.
ROGER POITRAS ~
• CLERK CIRCUIT COURT
RECORD ~'ERiF1f0._~~
496815 ~ ,
~ :
~ I FURTHER CERTIFY that I ~ register at m, locel address when the registration boots reopen. and camp(, with dl
I~ other requirements of a legal resided of this State.
I ~
I I FURTHER CERTIFY that I have no intention to return to my former domicile. and I intend to remain in
- UC 1 E _Count,.
Ilst~) .
Florida. permanensi;.
. _
_ ~
_ ~ ~ y
(olio o ~ - 1~i9~oA?At ~r/~u1/~3~
S~rorn,.to'~tid~uullsft~ed before me this
" da, of P, E~'C'E FLT
~ s
-
A.D.lo,
0,_~ °
ROGER POI TRAS. CLERK OF G IRCUI T COC~2T
ST. LUG I E COUNTY, f LOR 1 A ~ -
•
BY:
EPUTY LERK
. -
a~ X37 PEE 107 ~ :
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Af:n Fnrm 71 22