HomeMy WebLinkAbout2917Declaration of Domicile and Citizenshi ~
~ ~
sa.ossz
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG i E COU~y, ~,O~A;
Thb b mT declaration of Domidle and Citi:enslup in the Stale of Florida that I am Stloa thb d~ iA accordance. and b
coniormit~ whh Section ?22.1T, Florida Statutes.
I was i~ a kgai resident of ` ,~, '~-~ , and I
IOtUI ~ 18tau1
eesided at ! : i 4 0 ~nr~ . w ~.Q - However, I have changed ap domie9s to
Ifltnrt aad Nss~
and am and have been a bona fide resided of the State at Fbrida since ~~' dye[
c' ~ b
~ = Y~ c~,~~v...~l~e.\ ,19~ and I reside at 5' `~ `~ ~~rw:.Q1v~~ ~t J. R~~ o
z, . lt3+a.a aaa Nambsr)
~-1~;1-~ r-~- emu, ~, r,'1 ~_~ 4t __ ST. LUC 1 E Connt~. Florida,
10141
and this stateme~ b to be taken sa mT declaration a[ citizenship. actwl bgai reaidenee a~ domieDe in the State of Florida.
CHILDREN IN SCHOOL, PLEASE STATE
THEIR NAMES•
C- ~C ~Q ,,rJ
0
.,.
PLEASE CHECKS
PURPOSES,
1980 OTC 1 S IIM t I ~ 35
FILED ~kf FECORDEO
Sl. LUCtE CCU?! 1 Y. f t A.
ROGER PQITRAS
CLERK CIF.CUtT C~~
REfCPn ~ F i•'. ;t ~.
siossz
I P'[JRTSEIt CERTIFY that I wID register at m~ local address when the registration booms reopen, and oomph wk6 aU
other regnirements d a legal t+esident of thb State.
I FIJRTZTFR CER1'IFR that I have no intention to retarn tom former domia'le. and I intend to remain in
U C I E . Coont~,
ICt4)
Florida. permanemi; .
~ GOU~j j"
~:
'- C'
.J~
~ ~ G ,. _
z,
Sworn toand snbeeribed before methis ~`S daT of
~~ _ ~.n. ~
,~
`- • c~
- - - - _ - - ~
-~- ~ ~ ~~.
ROGER POITRAS, CLERK OF CIRCUIT COt~2T
ST. LUGiE COUNTY, FLORIDA
.,
~ - 8Y:
EPUTY t.ERK
Btu t~`S ~ pAGE ~7~0
-- ;r4
_ '=3
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD
-.,
.~
~~~
• i
nfn F~,.~, ~t ~