HomeMy WebLinkAbout0292f~~clarafion of Qan~icile and Ci~~z~ns~~ip
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TO THE CLERK OF THE CIRCUIT COURT.
ST. ' Ll1G 1 E CpvNry. ~-i,pRID~;
This is my dcelarstion o! Domic~e and G~tizensbip in tbe State oi Florida tbat I am 51ing this da~ in accordaoce. and in
conformit~ witD Section 2?2.17. Florida Statutes. ~ *
I R as lormerls a legal resident of ~ ~~ , ~-~-p snd I
~~ ~ /~1(~t~1 o~ IStat~1
resided at ~ ~`~a~ ~QJ 4~~Aowever. I bave chinged my domic7e to
(Street and Nmo~ -
and am and have been a bona Gde resident oi t6e State oi Florida sinoe • da~ ai
OZ ~~' ~/C~.st- ' 1Sl~* •
~ _ ,19 and I res~de st ~
(Stieet aad Number)
~~~ , t- ST. LUG 1 E Count~, Florida.
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and this statement is to be ~en as my declaraGon of citizenship. actual legal residenee and domicile in tbe State of Florida.
" IF FOR THE PURPOSE OF ENROLLING
CHIIDREN IN SCHOOL~ PLEASE STATE
THE IR NAMES~~~
.
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IP FOR HOMESTEAD-PURPOSES~ -
PLEASE CHECK: ~
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1981 J~t~ -7 F;~ 2~ 04
'rllFf !~C 4!'COPpfp
ST lUGF GQ~NTV.t `.A.
R(`GCR f`0lTRAS
CIERK CIR;,UtT C~?;E T ~
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512578
I F'URTI~R CERTII~'Y tbat I wi71 register at my local address v~hen the registratioa books reopen, and aomply witb aII
o:her requirements of a legal resident of this State.
I FURTHEA CERTIF'Y that I have no inteation to return to my former domic~e. and I intend to remain in
, 5T ? L U G 1 E ~~t~.
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Florida. permanenu;.
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Sworn to aad subscnbed betore me tbis
~
ROGER PO I TRAS#
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(Add»a~)
7 a,~ ~ ~~ ' ~ 3 3yS~
A.D._ ~98~ Lt~~e2 C'. 1~~PAg~ -
CLERK OF GIRGUIT COCd'2T
ST. Ll1C I E COUN7Y, f LOR 1 OA
BY:
. EPUTY I.LERK
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BOOK ~U PAGE ~~ _ , w ~ ~
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