HomeMy WebLinkAbout1474Deciaration of Domicile and Ci~izenship ~}-
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TO THE CI.ERR OF THE CIItCUTT OOUAT.
ST. LUC 1 E ~ apU~y, ~,p~A;
17~Is ~ ao~ deelaration oi DomicDe and CSti:eaship in tbe State -ot Florida that I sm Slina t6is dq ia aoo~rdmoa. and ia
confo~adt,~ witb Seetioo 222.17. ~7orida Statute=. ~
I was formerl~ a legal nsident ot % - ~• a~ I
lat7) 18ew1
n:ided st ~ s .~~-~,~ -- . Ho~vever. I bave ebanged tq~ domide to
18 ' and I~ooD~ -
and am and bave been a bona 6de nsident ottbe State ctFlorida ainoe ~~ -~i-ti.-• --~ ~~ dq d
~~ ut ~'a~- _ i~~~ . wd I reside at .~?~ 9 5 Lc.1 ~ 7C~ ~i~
'/ J l8tr:~t aad Numb~rl
~~~ ~~. -~.LC. ST. LUG 1 E Count,~.I~yo,r;d,~
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aad this stateme~ ~s to be takea as m~ deeLration o[ eitiunsbip. actual kgal residenee and domidle in the State ~ Floaida.
" IF FOR THE PURPOSE -OP ENROLl.ING
CHIL~REN IN SCHOOL~ PI.EASE STATE
THE1R NAMES:
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IF FOR HOMESTEAD~PURPOSES~ -
PLEASE CHECK: ~
1981 JAt~ 27 A~ r 0~+
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ST.LUCIf CGUY3Y.F1 A-
RG6ER POITRA5
CLERK CtRCU~I C: ~14?t/J .
c: Cc=°• ~~ F' ~' ~- ~f _ •
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I FURTHER CERTff'Y that I wr~ register at m~ loeal address ~vben tbe registratioo boob reopen. and o~mpb w~it6 aIl
other nqniremeat~ d a kgal reaide~ a[ this State.
I FIJIiTSEK CERTg'Y that I bave no intentioo to retnirn to former domia'k. aad I Intend to nmain ia
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F7orida. permine~„•.
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Sworn to aad sab~aibed befoz+e me tbit a ~ da~ d ~, ~ . ~. . ~ c _:.~ ~~ .-? ~ ~~ ~
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ROCER PQL~RA$~ CLERK OF CIRCUI T COt~2T ,
~ ST. LUG 1 E COUNTY, f LOR 1 OA •
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~ - - BY:
~ EPUT LERK
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