HomeMy WebLinkAbout2902~~clai-afiio~ ofi Dor~icit~ and Ci~~z~~~s~~ip
TO THE CI.ERK OF THE CIRCUIT COURT.
ST. Lt1G 1 E Cout~'t~t~ FLpRIDA:
412315
This is my deeluation oi Domiclle and GStizetLS6ip in the State of Florida thst I am fling this da~ in sccordunce. and in
conformit~ with Section T12.17. F7otida Statutes. ~
I a as formerl~ a legal resident oi v• l S$1 SSi ~d I
. l ' ISta1~
rrsided at ~~~O ~e~r vm~n ~1 c~~~i However. I have cbanged my domici7e to
(St,~cet and N~ber) ~
and am and ha~e been a bona 5de resident oithe Stste of Florida since ~C~ da~ ot
_ .~.~[1l)1~ V .19 ~+ (~ - and I res;de at ~7~ S • 11J. ~cZI~ShG~C, ~~~iC~ .
(S and Number)
~1- oR~ Sr .~.~c-~ ST. LUC I E
lc~t~) Count~, Floriaa.
And this statement is to be taken as my declara~on of titizenship, actual legal residence and domic~e in the State of Florida.
~t -
' IF iOR THE PURPOSE OF ENROLLING If FOR HONESTEAD PURPOSES~
CHItDREN IN SCHOOL~ P~EASE STATE PLEASE CHECK: ~
THEIR NAMES:
~12.315
.~
1961 JAN -5 Pu, 2- 26
fILEC ~MC F; CGNi1CD
s ROGER POITR~-SA.
CLEP.i{ C-~CUII C8UP1
~~~
Rif.Cf'^ ':j c F.~ ~ _ -
I FURTHER CERTIFY that I w~71 register at my local addres~ when the registration book.~ reopen. and wmpl~ v~ith all
o:her requiremeats of a legal resident of this State.
I FURTHER CERTIF'Y that I hsve no intention to return to my former domica7e. snd I intend to remain in
.e - T- U C 1 E . Count~.
((:R~) .
~Ortdi. permanenci~.
~ •
'~
~~
J`~.COUI~f~- c
~:f~~~~ ~:~ / . ~ (`
U '-. ,c~~~~' ~,~~ : ^~ .
~. " ........ ~~ ~? ~
_ '~:~~hlY._F~~ ~am~)
Sworn to and `nbxn'bed before me this ~ da~ of
(Addrep)
~ ~~ . ~.D.. / 98/
ROGER P01 TRAS. CLERK OF C i RCUI T COC~2T
ST. Ll1G i E GOUNTY, fLOR 10A •
. .,
BY: Q~Zu.Q,Q ~-~,
_ EPUTY LERK
~
~
.~.._ ~, :t~ z .. _ .~:~. .~ ,~ .. _ . = ~
,.
. .~, .
. _ ~ .
. .
~ ,
80~1K ~~3~J PaGr~ ~ • ' M ~ ~
~
~. ~ . _.~, w -~~~