HomeMy WebLinkAbout0711 ~ 1 .L
Declaration of Domicile and Citizenshi
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49'T213
TO THE CLERK OF THE CIRCUIT COURT. .
ST. LUC 1 E CpU~y, ~,pg~A;
This is mv7 declaration d Domie~7e and Citizenship in the State d Fbrida that I am fling this daT in aooordance, and is
ooaformit~ with Section 222.17. Fbrida Statutes. v
I was formerly a legal resident d l ~-~~,'e . ~ ~ ` and I
resided at ? l ~ ,L;~ 2 O~tP f^ Sd y1 /q~ L~ - Aowever. I have changed m,T domidk to
U3erNt gad Nomb~r) ~
and am and have been a bona aide resident d the State d Florida since ~ da7 of
19~ and I reside at ~
(8tnd red Hamba)
=~f ~,«h ~ ST . l UG i E CountT. Florida.
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and this statement is to be taken as mT declaration d Citizenship, actual legal residence and domia7e in the State d Florida.
I IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES, i
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~ {
THE 1 R NN/~A1~SS
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• 49'213
1980AU625 AHi1=30
ST~``EUOCI RCppR~~Epp~~CTY
FE A. 1
R06E~ POITRA~
CLERK CIRCUIT COUR,T~y~ ~
R[CORO VERIFIED. _ _ _ Q'
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I FtJRT~R CERTIFY that I ~I register at mT bal address .vhen tDe registration boob reopen. gad oomplT with all
I other regnirements d a legal nside~ d this State.
f I FURTHER CERTIFY that I Gave no iatenti.:n to return tom farmer domicile. and I intend to remain in
_ _ _ U G 1 E _ CountT.
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Florida. permanenu;.
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Sworn to fnd ~1~er~edbefore me this ~~ds, d
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ROGER POI TRA , CLERK OF CIRCUIT COC~tT
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ST. L I E COUNTY, f LOR 1 OA
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BY: . , ~ ~
EPUTY LERK 3
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8337 P~~ 71i - i . _ ~ ,
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