HomeMy WebLinkAbout1314Declarafion of Do~~icile a~d Ci~i~~nst~ip .~~
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Si3093
TO THE CLERK OF THE CIRCUIT COURT.
ST. LUG 1 E CpUNTy, FI,pRIDA; '
ThLs is my declaration oi Domic~e and Citizenship in the SLate of Florida that I am filing this da~ in aocordaaee. and in
coalormity w~th Section 222.17. Florida Statutes.
I w u iormerle a legal resideat oi ~LC Lc1 /~~~ ,/~ E6sJ ~D/~f~ and I
lCit7) IStatel
resided at ~7 r~ ~~N a~t~~~~~ • ~~~ , However. I have ehanged my domic7e to
(Street and hombes) ~
and am and have been a bona 5de resident of tbe StaLe of Florida sinee ~~ TOf~~/~ ~o day d
~TO~~~ ,19 0 O - and I reside st ! ~ `~` O ~/~•DNc I~- ~7` . ~.~
~ (Street aad Numbar)
~ ~PT ~T. L. ~JG~ E ST . L l1C I E Count~. F7orida.
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and this statemeat is to be taken as my declaration of citizenship. aetual legal residence and domic7e in the State of Florida.
' IF FOR THE PURPOSE OF ENROLLING
CHIL~REN IN SCHOOL~ PIEASE STATE
THEIR NAHES2
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,~
~ F' FOR HOMESTE/1D PURPOSESi -
PLEASE CHECKt ~ ~
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1981 J~N ~ 2 ~` ~r 28
~ FtLEO ChC FEGUR-:t, :
SS_tl,~GcR P {TR 15~-
~R~ jt CIRCl.-T ~~.~"~! ~
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513093
I FURTHER CERTIF'Y that I a~71 register at my ]oca] address when the registration books mopen, and eomply a-ith aD
other requirements oi a legal resident oi this State.
I FURTHER CERTIF'Y that I have no intention to ~ return to my former domic~e, and I inLend to remain in
.. r ~ .- -~ T? L U C 1 E ,(`,pu~ty.
r v ~T ~'r ~`+`eese,~ .
F7orida, permanenti;.
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Sworn to and subxnbed before mt thi~ ~ a~ da~ od_ ,~D/~ ~1`• ~t.~L /~ ;~~l ~J' ?~
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~,- e o r~~ t,c~ ~C v S~~
ROGER POI TRAS* CLERK OF C i RCUI T COC~2T .
ST. LUG 1 E COUNTY, f LOR 1 OA •
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- BY:~ ~ Q~,~ . • -
EPUTY ~LERK ~-
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