HomeMy WebLinkAbout1220 d
~ ~ ~ ~ ,
Declaration of Domicile and Citizenship
49'7498
TO TAE CLERK OF TAE CIRCUITOOURT,
ST. LUC 1 E COt1NTY, FLORIDA:
This is np deeLration a[ Domicils and Citiasaship in the State of I~7o~tlda that I am ~ this dp io aoeoedanos. and in
conformity with Seetioa 2?Z.17. Florida Statutes. .
I was for r a legal resident aI ~l! ~w~- ~ and I
lGt>rl letiel
resided ~ ~ ~
D 7 ~ ~c mac. /~'r . - $awevar. I have changed tqT domicile to
• t8h.rt a>ee N..b.r)
and am and have been a bona fide resident at the State oI Fioeida linos ~ ~ d
. lg...~~. and I reside at /t~ / 6~°../r,/sc~~
(tiaMt ase I~1rab~d
? ~~L.~. t3 lac, _ ST. LUG I E -
~Clyl .
and this statement is to be taken as mT dseLration of dti:enship, adnd legal residence and domieife is the State d >i7oeida.
' IF FOR THE PURPOSE Of ENROII.ING It- FOR MOMESTEA~ PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMESt c"""~~~A _ /
1.980 AUG 27 Nt ~ 55
FaEO ANC a~caROCo
ST. LUCIE COUNTY. FIA.
ROGER POITRAS
- _ CLERK CIttCUtT C
_ RECORD YERIFIEO__
- 49'7498
I F[JATAER CEATIF7f tbst I wID register at mT local address when the >r~drat3m bode rsoQsn. and eompy wkh all
other iegnirements of a legal raside~ of this State.
' I F[JRTAER CERTIE'Y that I have no intention to return to mT former domieik. and I intend to remain in
_ U IE
_ ~i wi _ ~ l W.....~.
- IQtlrl
Florida. permanenLl
j .
- - Y~r~ s
• w ''i
Y~ ~u--,lam
i
Sworn to and snbseribsd before me this ~ daT of
•
ROGER P01 TRAS. CLERK OF G IRGUI T COt~2T .
ST. UGIE COUNTY, FLORIDA
BY: -
_ BIlO~ .h.)
f
~
l~
Av0 Form 71-?2
---,x