HomeMy WebLinkAbout1404 Declaration. of Domicile and Citizenship
50454`7
TO THE CLERK OF THE CIItCUIT COURT.
ST. LUG 1 E CpU~y, t-tpg~A;
This is m~ deeLration of De®iole and Citir~saship in the state aI Florida that I am Sling this dad is aooordanoe. and is
- oonformit~ with sedioa 222.1. I.9orida statutes.
. ~ - .
I was i a kgal resident of and 1
resided at ~ ~ ~ ~ /y' ~In fcQ. i ttr V ~ - However. I have ebaged m7 domiei"k to _
18aMt and NoeDsrl ~ .
and am and have been a bona fide resident of the state osFloridasins -U•~ ~ ~v - . re co/i d dad d
0~_ ~ 1- _ 19~'D and beside at / S' S" ~C, i~ e ~~D
/ (ea..e aed N®ber)
~A., f ~,j'7`' .G i._ ~ ~ e _ ST . LUG I E Couat~. F9orida.
Itat7)
and this s4tement k to bs taken as m~ decoration aI eiti:enship. actual legal reaidenoe and domia'le in the State ei Vida.
If FOR THE PURPOSE 'OF ENROLlIN6.• If FOR MOMESTEAO PURPOSES,
CHILDREN iN SCHOOL, PLEASE STATE PLEASE CHECKS
THE1R~ NAMESS
~ 1
i°~0 QC~ 23 P!' ~p ~
S1.U3CiE cCti~TY.fI~.
ROGER POITR•SS
CIEf+K c:r-.c:l:T cup
50454'7
I F[JRT'1~R CERTg'Y that I wiII register at m~ local address when the rsgistrrtioe boob reopen. and eompl;F wltL all
otbez r~egatrements of a legal reaideat at this State.
I FUR1~ CERTIF~C that I have no intention to return to former domic'le. and I intend to remain in
P _ U C i E ~ Co~mt~.
II~t7)
Florida. permanenii; .
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- ~.:orobiitlr! 'ie~Qlbed before me tbis ~ daT of
ROGER POITRAS. CLERK OF CIRCUIT CO~dFtT ^ - •
ST. L I E COUNTY, fLOR 1 OA - ~ ~
.
EPUTY LERK
- ,341 P~Ei40~ _
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