HomeMy WebLinkAbout0269Q~clarafion ofi I~or~icile and Ci~iz~ns(~ip ~
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S12562
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TO THE CLERK OF THE CIRCUIT COURT.
ST. LUC I E ~outv~r~ Fi,pRIDA:
This is m~ deelaration o! Domic~e and Gytuenship in tbe State of Florida that I am filing this da~ in auordance. and in
conformit~ witb Sectioa 222.17. Fiorida Statutes. ~
I a as formerl~ a 1ega1 resident of .S~prC'/~I~l~~ S _ /~~`-~ J~~ S€ `~ and I
Q l(st7) lSt+i~l
resided at ~ 3~ ~' /~ ~~~D o~~ ~ n A b. , HoR ever. I bave cbznged my domiu7e to
' (Street aad N~ber)
and am and have been a bona Sde resident oithe State oi F7orida aince n/~`S d+U d
,19 ~L~ , and I reside at _~P~' ~ -S ~'~'' B~~' u T ~'- 7~
(Street and Number)
~~ r sT ;c ~ c, F , sr. LUG 1 E ~,~t~. ~,orias,
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and this statement is to be taken as my deelaration of citizenship. actual legal residence and domicile in the State of Florida. '
" IF FOR THE PURPOSE OP ENROLLING
CHtLDREN IN SCHOOI~ PIEASE STATE
THEIR NAMES:
- . ~/1~ ~C ~9 . w~« ~ A~ S
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IF FOR HOMESTEAD-PURPOSESi -
PLEASE CHEGKS ~ ~
t981 J~+'~ -7 Pt~, ~r 03
:,<<c R~c ~~ coPnia
5~. LUCI[ CGUHj Y f l A.
R~Gf R POITR%•5
CLEi•.K L'1=C?!' CGL'.'' f -
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512562
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I FIJRTHER CERTII~'Y that I w~71 register at my )ocal address when the registration books reopen. and compl~ witb aD
other requirements of a legal resident of this State.
I FI7RTHER CERT'If'Y that I have no intcntion to return to m~ forsner domieDe. and I intend to remain in
~a.~r c T- Ly- c. E ~_`-_; 5 T* L U C 1 E . Count~.
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Florida. permanenti~.
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Sa•aro to and subsrn'bed before me this ~ day of
~ ~~ ~ w.n. _ / 9 8/
ROGER POITRAS~ CLERK OF GIRCUIT COtdRT
ST. LUGIE COUNTY, FLORIOA -
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BY: ~ ~ -
-~ . ~EPUTY ~~ERK
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(Nam~)
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