HomeMy WebLinkAbout0566Declaration of Domicile and Citizenship ~"
' ~ 509150
TO THE CLERK OF THE CIRCUIT OOURT,
ST. LUC I E apU~y. ~,p~A;
Thb is nU declaration of Domidle and Citisenship in the State of Fbrida that I am ~g this daT fo aooordanos. and is
oontormitT wttb Section 222.17.1:7orida Statutes.
I wan i~ a kgal resident of ~L~ A C r-/ ~ M (/ ! sad I
tGt71 18tw)
resided at However. I have ehaoged mT domiede to
lBtrMt asd Neab~
and am and have bees a bona Sde resident of the State et Florida since ~~ / S ` daT aI
A v ~=. v s T .19 ~ y. sad I t~eside at / 0O7 - l3 /~i`~c~ A SA~vT /~u~V ~, 2
(8tre~t asd Nnmb~rl
/--O,f' ~' `~~ c--',~c ~- ST. LUG I E ~~, ~~,
tav~
and this statement is to be taken as aU declaration d citizenship. adnal kgai residence and dominle in the State o[)<7a~ida.
" If FOR THE PURPOSE Of ENROLLING IF iOR HOMESTEAD PURPOSES"-'
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKt
THEIR NAMES.
1980 OEC -3 AM 1Q 32
~_ FILEC AMC F.CaRU(A
SLLUCIE COUNTY.E A.
ROGER POITRA~
CLERK CfRCWT Ca~
_ REC6i10 VER!f!EC_
SU9150
I FURTHER t~RTIFY that I will register at mT focal address when the registration boobs reopen. sad eom~plf wit>f aD
other rcgniremenv d a kgal resident d this State.
I F[)RTHEK CERTIFY that I have no iatentioa to retara
Florida. permanentl,,•.
cr' ;; ,
ry ,~,~
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_,
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sad I intend to remain is
~7•
~ a~ S ~
Sworn to and wb.Qibed before me this 3 ~ oaf d ~ D ~- 7 ' ~3 ~/~~ ~•,. ; /c vv ~ i~
..
ROGER P01 TRAS, CLERK OF C IRGUI T COtdI2T .
ST. LUGIE COUNTY, FLORtOA
- BY:
<~~~~
~~EPUTY LERK
s~344 ~~ 566
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