HomeMy WebLinkAbout0163Declaration of Domicile and Citizenship ~'
SO8894
TO THE CLERK OF THE CIRC[JIT COURT.
ST. LUG I E COU~y, ~,p~A;
Thb is m,T declaration of Do®teDs and (~tisemhip is tbs Stars d Florida that I aaa lflioa this di,T is aooordanoe. and is
coniormit~ with Sidiaa ?22.17. Florida Statutes.
I was I~r a legal resident d C HA R~. £S ro,/ S' ~~J l/>F (~,/ ~dc /;,r¢-and I •
lot7) t81aW
resided at v7 6 O J ~ ~ ~ to G ~' ~ ~ ~ C- - However. I haw changed m,T domieSs to
(BteMt asd N>•1~
and am and have been a bons 5de resided d the state d Fbrida since / daT d
0 .19 7 9 - and I r+eaide at .~ S 6 ~ ~ fy %f T/f. dr ~ Ul7
lBhMt asd Noabrr)
J` r `'/ E /~ C r _ ST. lUG I E ~~, bra,
tavl
and this statement is to be taken as ml declaration d eitiunahip. actual legal reddenos and domia7e in the Stets d Florida.
" IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IH SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMESL
~~ ' ~ ~ ~ .his
ST IUWEtCCUNT~Y flA.
CLEAII CIRCW~T CHAS
RlilORp VfRiFtFtl~__~ ____`
594
I FlJR1~R t~RT11R that I wID register at m7 loea! address when the registration boob reopen. acct eomplT wits all
other regnirementa d a legal resident d this State.
I FURTHER CER1'1T'Y that I have no intention to return to former domidk. and I iatend to remain fa
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swam to and snbseribed before me this ~ daT d ~ T p/ ~I ~G E' F~.~ t3 -~ ~ ~
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ROGER P017RAS. CLERK OF G IRCUI T COt~ZT
ST.
BY:
LUGIE COUNTY, FLORiOA
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. PUTY I.ERK
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AGO Form 71-22
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