HomeMy WebLinkAbout0300 Declaration of Domicile and Citizenshi ~ '
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TO THHT': CLERK OF TIIE CIIIC[lIT COURT.
ST. LUG I E COU~y, ~,p~A:
This is m,T declaration d Domica7e and Citisanahip in the state d Florida the I am Sliaa this d~ in aooordance. and in
coniormitT with Section 222.17.167orda statutes.
I was foro3erl a 3ega1 e+esident d ~ ,~k'-~ .t'~~ _ ~ and I 1
c~ ) 18tau)
resided at ~ 3 sJ P_ rF, _t ~ ~ > > - However. I have ehaaged mT domidle to
t8wa aaa Hamb.r) •
and am and have been a bona Sde resident dthe State d Fbrida since ~7 d
~ - 291~b and I reside at a /l I mc~ n'~ i n~ rn ~ 1 ~ I~r>,; n~'
(ea.~t aed N~brd
t~c~rt . T. ~~~c i~° _ ST. LUG 1 E ~ti, Via,
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and this statement b to be taken as m~ deeLation d eitittnship. aettul legal residence and domic0e in the State d Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOt.~ PLEASE STATE PLEASE CHECK: ~ ~
THEIR NAMESt '
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~U SUS 2 I A1~i 09 _
iil~0 RNf FECOri1E0 i
sttuclE to~tY.FtA.
ROGER I'OITRAS
CLERI( CIRCUIT COURT
Rf'CORDYEPiF1EO__
49693'7
I FURTHER CERTIFY that I wID register at mT local address when the registration boobs :+eopen, and eomplT with aU
other regttinme~s d a legal resident d this State.
I FURTI~R CERTIFY that I have m intcntion to retorn to mF former domicile. and I intend to remain in
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c~'-i ~ _ Count.
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Florida. permanents; .
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~ ~ Swor>of tosiid~«.6 before me this __Ga~ daT d ~r,~'t ~f, L- ~r~i~ ~ ~a ~ f -rl
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A.D. i ~
R G •G ERK OF CIRCUIT COtdI2T .
ST. LUG I E COUNTY, FtOR t - -
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BY: f,
EP Y t.ERK
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A~:n Form 71 22 y