HomeMy WebLinkAbout0402 Declaration of Domicile and Citizenship ~ ~ t
I
S02'149
TO THE CLERK OF THE CIRCUIT OOURT. 1
STs L UC I E apU~y. FLORIDA:
Thin is m7 declaration of Domia7e and (htiseaship is the S4te d Florida that I saa ~ this daF is aooordanoe. and in
oontarmitF with Section 222.17. Florida Statutes. ~
1 was former a legal resident d ~~-yt m a t~ F i•/ _h.S „ _ ~ ~ ~ 1(1 D I S and I
. l(~it7) (8tase) i
resided at ~ 1103 A~ ~ 0 T Lff ~l/E However. I haw changed m7 domicile to i
(BttNt sad N~eoMr) /
and am and have bean a bona fide resident dtbe State eiFlo:ida since - r ~Oke~ ds,T d
l
~C tyBE,P -19.~, and I r+sride at ~ ~ ~ ~ .
sad Nsbw)
~t~es ~i E~CC 6 _ ST . LUG I E ~ CouatT.l:~orida.
1t1y1
and this statement is to be taken as mT deeLration d citi:enahip. actual legal reaidenos and do:oiciis is the State d 1:7aida.
I IF FOR THE PURPOSE Oi ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THE 1 R NAMES: ~ 1
- 51 l~l CIE
CCl17V
YFt~.
ROGER POITRAS
CiEAK ClRw~i CCUd~
502149
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I FURTHER CERTIFY that I will register at mp ]Deal addros when the registration books reopen. and oomph with all ~ `
other regniremeats d a legal resident d this State.f
f:
I FIJATHER ~CERTg'Y that I have no intention to return to mT former domicile. and I Mend to remain in {
U C 1 E ~ CountJ.
- 1(Xt~)
Florida. permanenci, .
,F
~~~OUNT
c I ~~~r~ V/CEr.
~J i ..oG /`e ~e tr ~ - f
UGC wi .O
O ~ a ~ ~fJ/~~.7ir K=i:_=.
- ~f COUKiV . F
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sworn to and snb.Qibed before me thin daF d
A,
. A.D.1$„~,1L^i.
ROGER POI TRAS. CLERK OF G IRCUI T COtdFtT
ST. LUGIE COUNTY, FLORIDA ~ .
BY: . ,
C:< _ .,J
. EPUTY LERK
•
. OR~
BOOK P~ .,;.i ~ .
ACn Furm 7l 22
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