HomeMy WebLinkAbout0146Declarafion of Qamicile and Ci~~z~nsf~ip ~
- ~ ~ s~ ~4ss `~
TO THE CLERK OF THE CIRC[Jl'T COURT. -
ST. LUG 1 E ~pv~y. F-t,pxIDA;
This is m~ deelan~tion ot DomicDe and Citizenship in t6e State of Florida that I am filing this da~ in accordance, and tn
coaiormtt~ with Section 222.17. Florida Statutes.
I a as lormerlR a 1ega1 resident oi /"f D 1~f0 ~"O D~ , ~~~ and I
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resided at ~ ~ ~~ ~ r~' ~~~ However, I have changed m~ domic~e Lo
IStreet aod Numbed ~
and am and have been a bona fide resident oi the State oi Florida since day d
~' ,19~~,. and i reside at ~~ ~ 4 ~~A w G R r ~ r
~ " " lStreet aDd Numberl
Ff ~~i ~ r t C _ S T. L UG 1 E County. Florida.
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and this ststemeat is Lo be taken as my declaratioa ot citizenship. actual legal residence and domin7e ia tbe State oi Florida.
" IF FOR THE PURPOSE OF ENROLLING
CHIL~REN IN SCNOOL~ PLEASE STATE
THEIR NAMESt
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IF FOR HONESTEAO-PURPOSES~ - .
PLEASE CHECK: ~ ;
1981 JAN -7 AN ~ 52
fi~~e:Kr ~~toanro
S1.lUCtE COtMl~Y.FLA.
R06ER POITRAS
CIERK CIRCU)i CGU~T~
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s~ z4ss
I FURT~R CERTg'Y t6ati I w~l register at my local addreu vvhen the registration books reopen. and oompl~ wit6 all
other requirements of a legal resident oi tbis State.
I F[JRT~ CERTIF'Y tl~at I have no inteation to return to m~ former domic~e. and I intend to remain in
""-"--- 5T ,. L U C 1 E . Count~.
l(St~) .
F'lorida. permanenti;.
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Sworn to and subxn'bed before me tbis ~~ daJ of ~~ ~` ~~
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ROGER PO I TRAS~ CLERK OF C IRCUI T COC~tT / p ~ n~} ~ ~~,~ r~
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