HomeMy WebLinkAbout2500 i~r~c~~ratian ~a~fi D~mdCii~ ar~d C~~i~~?nship
~ ~ ~
. ~ .
. .
TO TIIE CL~ftK OR Tf1E CIRCUIT COUItT, 315~~4 . .
ST. L l1C i E ~pV~y. ~,p~pA: . _
This b mr declaratton of Domicile and CitiscnsAip in the Slate ot Florida that I am piag thts dyr in ~eeordAnee. at+d in ,
eontormity with Sectton 7.~.17. Florida Statutes. - '
.
1 w~?s tormcrl a kgal resldcnt oi - ~nd I
. lC~tpl ISt~te)
scstdcd ~t liowevor. l iuive ebaaged my domi¢ilc to
l6trest and Nua~be~) ~ •
and am and hav~ becn: bona fidc scsidcnt ot the Staio ot Florida sincs day ot
19~~. and I reslde at ~l~/~ ~ rr,[!~/'/. f'P ~ .
lStroet ~nd NumDer)
~..'~'j~ f- ~o ST . L UG I E County. Florida.
(CK~1 -
and tbis statemeM is to be taken as my declar~tion ot citizcnship, aMuql kgal residencc and domieilc in tha Statc ot Flori~e.
IF POR tHE PURPOSE OP ENROLIING I~ i'OR HOHESTEAO PURPOSES~
CHiIDREN IN SCHOOL~ PLEASE STA7E P~EASE CNECKt ~
THEIR NANES:
f~~LUC1E GO~~TY /L~
~OCE~ P8lTR~~
Cl Ee~K o'i~CU1T COURT ~
~ RRCG7~ Y£51Fi~0.,...~..~,.
~ - ~ . A~ 18 f PN'75.
~ - 3~5~Q4 .
I FU}tTlIER CERTIFY tha~ 1 will regi~ter al my local address when the rcgistralion books reopen. and corr.ply wiih ali
` othcr requircmenls of a Iegal residrnl oi this State.
` I FURT}IE~ CE~R~TIFY l t I have no int~ntion to rcturn to my formcr domicile. and I intcnd to remxin in
E ~ ~[°ff D , $7 L U C I C . Caunly. .
! «r~ -
~ Florida, permancnti;. .
. .
•
` ~ ~
~
. ~
~ ~ .
~ ~
g
- .
. S , J i.i.•,•C0 ~ ~~i.~c:~//•
•,;~U: ` G ~
'f •y.i',~.~.`'~'~l
~
~Q~%~ ~ ~a?e) ~~iG.7G~L=
~n • s~" `r • c S ~ IAdJres~) ~
~ - ~wo~~ ~•pt ilx~dl~cioro me this dn of [
~ ' V' : y i
, r. ; . ~ ; 75„ :
~ • ' n.n. F
~Pg.~,..~ .
„
' '
~ ROCr'ft'~PtS~~TR S,~CI.ERK. 4F C IRGUlT GOU2T ;
_ :--..~s - -
~ ' `
~ ST. Ll~ 1~ COUNTY, FL.OR 1 f)A `
~ f3Y: .
~cc~c w~~J
~ ~ TY LEItK
i
~ ~~42 ~~i0~
~ . . n~:~~ F-,~?„~
• . _
_ :
s ~ - -