HomeMy WebLinkAbout1622 Declaration.of Domicile and Citizenship .
so~sas
TO TBE CLERR OF THE CIItCUIT OOUAT.
ST . L UC I E ppv~p, ~,,p~A;
Thi: k anT decLratios of Domia'k and C~tiseaship is the State d I'~orida that I am 51ias this daT is aooordanae. and is ~
• aooiormitT with Section ~.1T. Fiodda 3tatutea.
I was f ~e a kcal ~sdent of S iY ~.V G T'o n1 ~ - -.and I
•tCiy) - (tiut~
resided at / 2 D ~ ~ 2 T2 A ,J i ' ~ ~/E - However. I have ehanasd my domie~s to
ltiawt~osiN~iwN
and am and have been a bona fide reaideat of the State at Fiarida sins ~ 7~ dad d
VG7d 8 ~.P .1~
~ and beside at /a2 S 8 ~.~.t/d S ~ N Q ~ t7
~ E,ec ~ ST. tt~..ct~.aNos~.rl
LUG i E
Y
and this statement is to bs tabn sa ~ deelaratien d eiti:enship. actual legal reeodenoe and domicile is the State ei F'larida.
" 1F fOR THE PURPOSE'OP ENROt.t.INC If iOR NONESTEAD PURPOSES,
CHILDREN 'IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NANESS ~ ~
t~
!9 0 OCT 24 Ate i I ~ 18
_ Fll~ RkC F~CGn.?t ~
- S ROGER
POITRAS~ •
CLERK CIRC:~It C04'R?~
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504686
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I F[JRTHER G~EtTIY'Y that I wID reaistes at mT bnl address when the registration boob reopen. and eompl,~ witL aD
other regoirementa d a legal s+aodeat of this State.
'i
I F[JRTEEB ~R that T have no intention to return to termer do~mieile. and I intend to remain io
_ U C i E _ Coant~.
ItXT)
F~ida. permaneail;
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ROGER POITRAS. CLERK OF CIRCUIT CO~d2T ~ • -
ST. LUG I E COUNTY, F1.OR t OA j
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EPUTY LERK
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