HomeMy WebLinkAbout0574
~~cla~~aiion ofi !]o~~icile and Cif~z~nsi~ip ~ ~
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512'732
TO THE CLERK OF THE CIRCUIT COURT.
ST. ~ LUG 1 E ~puNTy~ FI,pRIDA:
This is m~ declaratian of Domic~e aad Gtitizenship in the State of Florida that I um filing this da~ in aocordance. and in
conformit~ with Section 222.17. Florida Statutes. ~
I a•as tormerls a legal resident oi ~/a f S ,~~~~ ! f'y /"~c n S u1= C~, L7 `~o! ~'/~, and I
,Q~,~~ lat>> ~s~t'
resided at ~ /TY "' ~ . HoRever. I have ehanged m~ domic~e to
(Stis~t and N~mber) ~ /_
and sm and have been a bons fide resident of the State oi Florida since ~~/~~~ /~ ~ day oi
- 19 , and I reside at y-S U`S ~~~ ~-
~~ (St~et and Number)
~'// ~~~ c/ ~ ST . L lJG 1 E County, Florida,
~ ~ /~ ~ .
~~>>
and this statement is to be taken as my declaration oi citizenship. adual legal reaidence and domicile in the State of F7orida.
" I F fOR THE PURPOSE OP ENROLL ING
CHILDREN IN SCHOOL~ PLEA~SE STATE
THE1R NAMES2
~,~ / ~'a ~
~ Qr ~~ ~K,,~. SL-" So ~
,:-~t-~
IF FOR HOMESTEA~ PURPOSES~
PLEASE CHECKZ ~
19~1 JAN -$ ~ t~ ~6
Sl tt1C~E ~OUy ~Y F~ a'
ROGER POITRAS
'CLERK CtRC~liT CCtiR~`
ii. ,~.r" ` ~ ' ~
. 512'732
I FURTHER CERTIFY that I aai register at my local address vohen the registration book~ reopen. aad eompl~ with aD
other requiremenb of a legal resident of t6is State.
I FURTHER CERTIFY that I have no intration to return to m~ former domic7e. and I intend to remain in
= 5 T, L U C i E , Count~.
IC'a~) .
Flo: ida. permanenti;.
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Sworn to and substnbed before me tbis O da~ o~ ~5 V S N~~~- _ J
~ C ~.D.. /98/ ~ _~,~;~~~~
C~ _ ~p 7h ~ 1... ~ o. Y~n ~ .
RO POITRAS~ CIERK OF GIRCUIT COCdi2T ,
ST. LUG t E GOUNTY, fLOR 1 OA •
BY: C
~ EPUTY ~ERK
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