HomeMy WebLinkAbout2916Declaration of Domicile and Citizenship ~/
' S].A561
TO THE CLERK OF THE CIRCUIT OOURT.
ST. LUG 1 E apU~y. ~,Og~A;
Thb b m,T declaration d DomicDs and Citi:emhip in the State d Florida that I am Gina thb da,T iA aooordanos. and is
conformity with Section 222.17. Fbrida Statubs.
I was i~ a legal resident d ~ 4 />> o n/ T /YEw cJE"~S E'y _ and I
171 l8tatd
resided at /39 - ~iP ESS ~C/~c ~ /~ ~~ E However. I have changed ap domiAe b
l8t~st asd Nss~
cad am cad Gave been a bona Kde resided oaf the State d Florida since ; -~ F/ ~ s r dq d
A y .19 a y~ and I reside at ~ O /~ ~/~ t-< E ~a~
18t~«taadP
~.e r S-T ~ ~. c .~ ST. LUC I E ~~~ ~
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and this stateme~ is b be fates as mp declaration d titiunship. actual bbd residence cad domicDe in tbs State d l!9orida.
" IF FOR THE PURPOS~OP ENROLt.ING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: r /'I
THEIR NAMES: ~, / 1
'~ t960 QED I5 AM II= 20
.~.
FlLEQ Rti[ !~E'COR11f0
S1.LUCIE COUNTY.iI A.
ROGER POITRAS
CLERK CIRCUIT CQL'RT
514561
I FURTHER CERTIFY that I wfll register at ssT local address when the rsgistratioo bode reopen, and eomp~ with aU
other regniremeats d a legal reaide~ d this State.
I FURRIER CERTII•'Y that I have ao intention to return b m7 former
F7ocida. permanemi,-.
«.. ~. ~~
U .= , e~ mix: ~ .•' c
cad I iobad to remain is
~T.
~' 0 ~ .
Sworn to and snbseribed befoa~e me this ~ daj d ~~~~-T _ ~~.
ROGER POITRAS. CLERK OF CIRCUIT ~OtdtT
ST. LUGIE COUNTY, fLOR10A
- - 8YZ ~~..
EPUTY t.ERK
B~(J`f~ P4GE~
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AGn Form 7I-?2 ~
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