HomeMy WebLinkAbout2413 , . . , y~
i~~c~~ra~~~n ~~m~c~te and C~t~z~~sh~p
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TO THE CLkRK Ol~' THE CIRCUIT COURT, 31~0 •
sr. ~ uc ~ e covrrr~r. ~.onin~: ~ -
Th~s b mr decl~rntioa o[ Domicilo and Cltiscnship in the Slato ot Fbr~da that I am C~liag tAis day ta aceosdaneo. ~nd in ,
confocmity witb Sectton 2'..~' .17. Florida Statutea. ' ~
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1 was formcrlY a kgal residont ot/~.~ES1-,~PBH.(i i , fi~t/ I ~
~ t~71 IStat~I
residcd ~t ~v ~ v~ ii~ I }iowevcr. ! fu~vc ch~~ged my domicile to
tRtts~t wd Numbsr) •
and am u~d havc bcca a boru !'~dc rnsideat of the St~tc of I~'lvrida sinea _ g/~ tLr ot
l9~_~ and 1 reside at ~~~/ylGts
v~
~ (Stre~t at?d Nnw~er)
' u' • ST. LUG 1 E County. Florids,
ta~r~'
~ad this statement is to be taken Rs my dec4r~lion of citizenship. aMuai legd residencc and domieile in thc St~?to ot Florids.
IF FOR THE PURPOSE Of ENROL~iMG IF' iOR HOHESYEA~ PURPOSES~
CHILDREN IN SCHOOL~ PLEASE STATE ~ PI.CASE CHECKS ~
THEIR NAHES: ~ ~
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~ L- N l..° ~ ~
~ M~ e e • ri~eo ~ O~'
~ fT- tt1C1E COtlNTY F?A. -
A~~E~ a~.,~i~S S~
CLfF+c ,LUiT COURT t~~~ .
. PC(!~rr yc~ F~~~~.~.~~~\
~ . ~ Adc ~ ~ 3 0~ P~i '15
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1 FURTIIEIt CF,RTIFY tha~ I will register at my local address vvhen the registration bonks rcw~?en. and comply ~vith aU
' olhcr requirements ot u Icbal residcnt ai this State.
I
~ RTIi~R CE TII~Y,that 1 havc no intention ta rciurn to my formcr domicilc, and I intend to rcmain in
UG/~ , ST . LUC 1 E .C.~~uoly.
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~ Florida. pcrmanrnti;.
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~ Sworn lo nnJ ~u?iei:ril,c~d tn~turc u~e thi~ _ day of /~"4 . iG -
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~ Rn('ar_~ 011"RA CLf:RK OF C If:GUI T COUtT
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~ ST. L tK I L' COUNTY, F I.OR 1 UA -
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~ ~ goaK 24~ ~E 2415 .
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