HomeMy WebLinkAbout2861~3ec~ar•ation ofi Dornicil~ ai~d Ciiiz~nsfiip ~
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TO THE CLERK OF TNE CIRCUIT COURT.
ST. Ll1G 1 E Covrr~r. ~.oRin~: ~
Th~.t js m~ deelsratioa ot Domiu7e and Citizeaship In the State oi Florida that I am f~7ing thLs da~ in aceordance~ and in
conformit~ w~th Seetioo 222,17. F7orida Statutes.
I a•as formerl~ a legal resident of 411~ i~G ~QY~./= , and I
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resided at ~~ ~ H/[~~~ n v~ ~~ ~~~, However. I bsve ebaaged m~ domic~e to
(Stre•ei~and N~ba)
and am and have been a bona rde resident of the State of F7orida since ~ cl~ ~P~t'J da~ o~
~.~ta~ ,19 ~/ - and I reside at ~ ~ v~ a ~~ ' ~ ~/J
. (3treet +~~d lVumbv)
~ r" ~/ ~rc_ ~ ST. L UG 1 E County, FJorida,
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and this statement is to be taken ~s my declaration of eitizenship. actual legal re~idence and domic7e in the State of Florida.
" IF FOR THE PURPOSE OP ENROLLING IF FOR HOHESTEAD PURPOSES~
CHIL~REN IN SCHOOL~ PLEASE STATE PLEASE CHECKS ~
THEIR NANESS
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I FURTHER CERTTFY that I w~71 register at m~ local address when the registration books reopen, and eompl~ witb uL'
o:her requiremenb af a Iegai resident of this State.
I F[,'RT'HER CERTff'Y that I have no intention to rrturn to m~ lormer domie~e. and I intend to remain in
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~o: ida. permanenti;.
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Sworn to and subxnbed before me thi~ ~~ da~ ot ~~ ~~ D/~..~ ~ O b~o ~0
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ROGER POi TRAS~ CLERK OF C IRCUI T COCdi~T
ST. L l1G I E GOUNTY, f LOR t OA ~
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BY: i
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EPUTY LERK
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