HomeMy WebLinkAbout2887i~~c{ara~ion of Dar~~icile ai~d Ci~i~~nsi~ip .~
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TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E covrrrsr, ~.oRm~:
This is mJ deelaration of Domic~e and Citizenship in the State of Florida that I am filing thi~ da~ in accordanee. and in
tonfarmit~ v~-ith Section 222.17. F7orids Slatutrs. ~
I w as formerly a legal resident oi ``~V~tP'V =~ , /UP~ ~O i~ ~ and I
~ lCit71 lStatel
resided at ~~ ~ Cflr ~ ~/' ~e However. S have ehanged my domic~~e to
(S eet and Number) ~
and am and have been a bona fide resident of the State of Florida since __ ~ _ ~_ day of
.~ ~' .19~G~ - and I res;de at ~~4c~ G ~~~ COjon~`' ~~:A~~D _~_~D/
C~ IStrr_t a.~d Ne#~1
,~„ -~ , ST . L l1C I E Count~. Flo: ida,
t(.tit~1
and this statement is to be taken as my declaratioa of eitizenship. actual )e~al residenee nnd domic-~e in the Siate of Florida.
IF FOR TNE PURPOSE OF ENROLLING
CHILDREN IN SGHOOL~ PLEASE STATE
THEIR NANESt
IP FOR HOHESTEAO PURPOSES~
PIEASE CHECK: l
_~._J
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1981 JnN -5 P~' 2~ 07 ~
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sLWCiEcCU.rt~r.Fi.,~. ~
ROGER POt i R„S
1A
CCERi~ CIR;viI ~t-!JR'
R~CGr''. . :r. .
I FURT'~~R CERTIFY that I v~11 register at m~ local address when the regisir, tion books reopen, aad oompl~ vvith aD
o:her requiremenb ot a Iegsl residefli oi this Slata.
I FURTHE~ CERTII~'Y thst I have no inteation to retura to m~ former domic~e, and I intend to remnin in
~-¢n3~•~ ~~.," -- •- - _ JT , L UC 1 E , Count~.
(C'rt~1 .
f•
Florida, permnnenu~.
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Sworo tap utid~',~\xssbed before me this ~-~ da~ of
~ ~ ~-~-~ ~ tiD.. / 98/
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RO~POI TRAS# LERK OF C IRCUI T C0t~2T
ST. LUG 1 E COUNTY, FLOR ~UA ~.3
BY: ~
~~ ~ ~ •,Ls, f Cl,c~tii
'~~? / UEPUTY I.LERK
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