HomeMy WebLinkAbout0373 Declaration of Domicile and Citizenship
5()'73'71
TO THE CLERK OF THE CIRCUIT COURT.
ST. L UG I E COUNTY. FLORIDA: - ' -
This is my declaration of Domic~7e and Citizenship in the State of Fbrida that I am filing this day is aeoordanoe. and in
conformity with Section 222.17. Florida Statutes.
I was formed a k resid of / _ ~e t
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resided at However. I have changed my domicile to
18tr~at and Naasearl
and am and have been a bona fide resident of the State of Florida since ~ ~ day of
l 19.~. and I reside at ~ ~C~f2P,1 A
18trart aad N~berl
~J ~c_.Q.~S~Q . ST . L UG I E cagy.l:7arida,
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and this statement is to be taken as my declaration of citizenship. actual kgai residence and domiale in the State of Flaeida.
" IF POR THE PURPOSE OP ENROLLING Ii FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES: ~_1
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I FURTHER CERTIFY that I will register at my local address when the registration books reopen. and comply with all
E Othe! requirements of a legal resident of this State.
I FURTHER CERTII~`Y that I have no intentan to retun tom former domicile. and I intend to remain in
U C I E County.
(City)
Florida. permanensi, .
5
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. SU'73'71
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- swpa to and snbaaribed before me this ~ day of ~ ~ i1~' ~ . ~
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ROGER POITRAS. CLERK OF CIRCUIT ~Ot~'tT
_ sT, uC I E cour~TY, FLOR ~ oA
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BQ~K343 ~aGE _ ~ -y
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