HomeMy WebLinkAbout0653 Declaration of Domicile and Citizenshi ~
P
4:71'70
TO THE CLERK OF THE CDtCUIT OOURT.
ST. L UG I E ppv~y, ~,p~A;
This is my declaration d Domin'le and Citizenship in the State of Florida that I am fliaa this dq m accordance. and in
coaformitj with Section 2?2.1T. Florida Statates.
I was formerh a legal resident d ~ 'e U , ~ . - _ e ~ ~ ~ C and I -
1 ! _ iStaW
resided at to . C C C1 C~ , \ ) ~ `P n l ~ C- _ However. I have domia7e to
~ ~8~ ~7
l8teess aaa I~tme4+r1 ~`j
and am and have been a bona Sde resident d the State d Flo~tida since ~e / daj d ,
19_.51, and I reside at 93 ~ W a ~r n e ~ ~/C~e _
Ff • ~ ~ rC ~ ST. LUG I E Nam
lave
and this stateme~ is to be taken as my deeLiatioo d citizemhip. actual legal residence and domio~e is the State d Florida. .
IF FOR THE PURPOSE OF ENROLLING IF fOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NANESS ~
-C-u~~~S ne~! Sm~~~~.
_ ,r
49'71'70 -
~O ~U~ 25 ~N ~ 24
F ~1[ fxC~ Y j
_ ? St~ POITRAS~ -
CiERK CRtgNT COUAt
FiLGA01'EF~iiEn. ~--~t---- -
I FURTHER C1:RTff'Y that I wdl register at my lxil address when the registration boob reopen. and comply with all
other regairemeMs d a legal :eside~ d this State.
I FURTHER -CERI7FY that I have no intention to retara tom loaner domia7e. and I intend to remain is
_ o _ U C I E • County.
It7icrl _
Florida, permanenu; . ,
CQ ~ ~{`ti
f`-•. •'c
n
S.vorn to and anbsaibed before me this day d ~ i e Y' C ~ ~ I ~ • _ - ~ ~ S y -
ROGER A CLERK OF- CIRCUIT COt~FtT
'ST. LUG 1 E COUNTY, FtOR 1 - -
' 1
EPUTT LERK ~ ~
e00~Je71 ~e~
?~GE ~ ~ .
- -
~~n r,.T 41 :'2
~.Y
• _~.Y