HomeMy WebLinkAbout0294D~claraiion of Domicile and Ci~iz~ns~~ip
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TO THE CLERK OF THE CIRCUIT COURT.
ST. Ll1C i E ~p~Ty. ~,p~A; '
This is m~ deelaration oi Domic7e and Gtitizenslup in tbe State of Florida that I am filing this ds~ in acoordanee. and in
coatormit~ wit6 Section 222.17. F7orida Statutes. ~
I was formerl a legal resident oi ~Q~'Lv ,U _ /VC u/ ~o ~e l~ and I
~~~ lCit~) (Stai~)
resided it f~e ~ ~ T - Hoa ever. I have ebnnged my domic~le to _
(Street aad N~ber) ~
and am and have been a bona Sde resident of t6e State oi F7orida since cT o7 ~~ / 9~D _ da~ o[
19~TL, andIre9dcat ~.~e_ 3~l /7A~v Fo.e~ ~
-~ 8treet aad Number)
~~ 7-- _~f . ~L t.~, ~ = ST. LUG I E ~
t(St7)
IP FOR NOHESTEAD
PIEASE CNECK:
and this ststement is to be ta]cen as my declaratioa of citizenship. actual tegal residence and doaticile in the State oi Florida. :
' IF FOR THE PURPOSE OF ENROLLING
CHILDREN IN SCHOOL~ PLEASE ST/1TE
THEIR NAMES.
Count7. F7orida,
PURPOSES~ -
t
19~ J~N -7 P~: 2~ 13
FIL~Q RNC ". CUPUf!-
ST.IUCIE CCIiNTY.F t A.
ROGfR POITRAS
- CLERK Ctf:CUli r~:;nT~
RFCC'r.^ :.; r.. . ~ _
512580
I FURT~~B CERTffY that I w~11 register at my loca) address when the registration booka reopea, and comply witb aD
ofher requirements of a legal resident oi this State.
1 FURTHER CERTIF'Y that I have no intention to retnrn to m~ tormer domic7e. and I intend to remain in
T. U C 1 E . Count~.
IfSt~) .
Florida. permanent3;.
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' ~ ~?G ~e~l ~D..v= lT_ ~GRNAT ~
~ ,/ (TZame) /~
_ ~ o ~-2 f~i4./FoR D /C ~5 .
!~ (Addrea)
Sworn to and subsenbed befon me this ~ ds~ of ~7_ e T ~_ ,l uc , E f~i4 3 3~S~
A.D. _~ 9 8~ G~. r~ Id ~ n e.. ~'r . A d u r n R~~
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R O G P O I TR A S. G L E R K O F G I R C U I T C O C~ 2 T
ST. LUG 1 E COUNTY, FLOR t ~A •
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- BY: • • • .
EPUTY LERK
; : - . ~346 PA~E 292
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