HomeMy WebLinkAbout0004 Declaration of Domicile and Citizenship y`
498442 ~ -
TO Tim CLERK OFTAE CIItCIJTP COURT.
ST. LUGIE ~ ?
OOUNTY. FLORIDA: !
- This is aq declaration of DomieRs and (xtissaship in the. State of 1.7orida that I am i~ this dq in aooadaoos. aad•in
• coeJccmitT with Section 2?Z.17. Florida Statutes.
I was f
~ a heal resident of _ ~ b •i n ~ • 15,T,.~
~t.~~,~? ana I •
resided st ) dti n / l' i ~Gt d ~e n U r~V e ~ ~ - Hows~er, I ba~eehanSed m,7 domia'k to
lea..c.ad Nes~e.d
and am and have been a boas 5de resident o[ the State of Fbsida sins ~ S ~ ~ ~
e Y' 19 o v • aad I reside at f
~
~ JQ r ~ ~ / n
n 18a.a ad Ha~b~r)
_„j~ r T S ~ ~ u c. l ~ _ ST . LUG 1 E coant~. Fio~rida.
and this statement is to be tal~en as ~ declaration d dtisenship. actual keel reaidenos and domie~e is the Btate of Fbeida.
" IF FOR THE PURPOSE OF ENROLLING ~ IF FOR HOMESTEAD PURPOSES,
';.4„ CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
~ THEIR NAMES:
.f~n~~ ~Qne 1~~~
_ i~
_ _ S ~
J a s a r, S h a ~ ~ ~ ~ : ~ er 1980 SEP -5 Phi 1: 11
FILED RENO Ff~CtUY
l A
5 ROGER
POITRAS
CLERK CIRCUIT CO~T~
- RECttRp YFPt~tFR f
' 498442
I 1•'i1RT1IEIi CERT11•'Y that I w~ register at m7 ]Deal addeess when the registration booms reopen. and oomph with all
other requirements of a legal r of this State.
I FURTI~R CERTIFY that I have ao intention to' return tom former domia7e. and I intend to remain in
U C 1 E ~ County.
_ (Qkj)
~ Florida. permanenci; .
is
E
:c
Vi
j r~ ~a.. ~~.r n (~/I~~rSDn ~ l ~ ~
cif ~OUNTY.F~'~Q / cJ / J ~-t f ~ 1 Yl c~-
r ~
¢ Sworn to aad sabertibed before ms this S r
daT od ~D r ~~7'_ 1 ~ / c_ f .
• .~Q,~ u - A.D. li~.SG-.~. .
- ~
ROGER POITRAS. CLERK OF CIRCUIT COl~2T , -
ST. LUGIE COUNTY, FLORIDA - - ~
r
^/Jy/y~/~r~,~ ///J(pt/ t ~ 5
BY: _~r
~ EPUTY LERK
_ ~
. _
• 'tlli
8~~~ Pa~E 4
AGO Form 71 22 ~
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