HomeMy WebLinkAbout0179 Declaration of Domicile and Citiienshi
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TO THE Q.EI;K OF THE CIIiCU1T COURT.
ST. LUC I E ~OUNZy. FLORIDA:
This is m7 declaration d Domin7e and Citiseaship in the State of Florida that I am filing this daT is aooordaaas, and in
ooofarmitT with Ssetiaa ?22.17. Florida Statutes.
1 was tom a legal resident d Q Q f0~'I ~~cX sad I
IC~itrl 18tattl
resided u - 'S'~~*~ s'S~ . However. I have changed m~ domials to
(BtrMt ~sd NrmDee) -
and am sad have been a bona fide resident d the State a[ Fbrida sins S dad d
~1u11 P .19.,.1,,, and I reside at ~°2 ~
F~~ /~ierc ~ ST. LUG I Et~..cmarr~l
Connt~. Florida,
111
and this statement is to be taken as nq~ dee]aratioo d eiti:enship. actual Segal residence and domid~ in the State d Flaeida.
IF FOR THE PURPOSE OP ENROLt.ING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
. THEIR NAMES:
- 5U1996
-
190 0`T -3 PI! ~ 04
F1LEC p?iC Gunui I:
Si.l!lCli' CClr!1TY.f: 3-
ROGER POfTRA5
- CLERK CIFCUIT C4URi ~
0
I FURTt~R CERTIFY that I w~71 register at local address when the registration books reopen. sad oomph with aII
other requirements d a legal resided d this State.
I F[JRZ~R -CERTIFY that I have no intention to retm~n to m~ former domicile. sad I intend to remain in
. _ uc ~ E ~t~,
1(5t~) .
Florida. permsnen~i,.
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ac = E:: - -~L
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Swore to sad anbeeribed betor+e me this 3 dad oI -
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A.I).1~~
R~ER P01 TRAS. GLERK OF CIRCUIT COt~2T
ST. L UG I E COUNTY, f LOR t OA ~ ~ _ .
_ ,
BY: n s
r
EPUTY LERK
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