HomeMy WebLinkAbout0143 1 . • • ' . . .
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TO THE CI.E;RK OR THE CIBCUIT COURT. ~1a~}S6
ST ~ L UC 1 E ~;pUN't'Y. ~,pRIDA: • ~
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Tb~s ts my declaration oi Domfcile and Cithoruhip ia the State ot I~`lorid~ th~t I a~n qiag this d~,~r ja accordaneo. ~nd in
oontoraaicy wi~h SccctoA 222.i7. Florids Sueutes. . .
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GI~AN/~Y ~ ~ ' I
I was to~ a Icgal roaideat oi - ,~l SS ~ u f' ' and I ~ ,
_ ICIV) l8tat~) i
residcd at - ~ v Iiowever. I bava chan~ed my domicKlo to
lset.~t.~d Nve.eer) .
•ad am u~d havo beca a bona fid~ residant of the Stato of Fbsida ataee a~ ~
~/T~ .19.,Z~,. a I reside aL ~ ~S 3 /i'~/ ~S ~ lip~ _
~ tStreK ~wd Nacnberl
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t~r County. Florida.
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~nd lhls statement is to be takca ~s my dec4ration of citizcnship. actual legal rasideACe and domicile ia ihe State of b'lorida.
_ I P fOR THE PURPOSE OF ENROLL iNG . i f' i'OR HOHES7EA0 PURPOSES~
CHILaREN IN SCHOOI~ PLEASE STATE ~P~EASE CNECKt ~
THEfR NANESL
.~3~ 1~ ~t/ .~s TTo,Z ~
- i lEp ~Nt+ RECOROE
i~. ~UCIE C4ttM1Y f.~ ~
CLERKCC1itQU T CO{MT
" RECQR~ VERIFIED~~
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I FURTHER CERTIFY that I will segistcr at my local addresa when thc rcgistration books reopcn.~and eomply with aU
othcr requirements o[ a Icgal residenl of this State. .
I FURT]iE~ CER~
JFY ihat I have no intention to tetnrn to my farmer domica'le. and I intcnd lo remain io
~,~-1~~ ~ ~'C -c ST . L u c~ E
. County.
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~ Flocida. permanenti;. • .
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: Swdr ~d~$i~ ` d i~etura mo this ~._~day of
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~ R(lGf•_R P01 T S, Cl_ERK OF C IRCUI T COIAtT ~
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~ ST. LUC I C COUNTY, FLOR 1.OA
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~ ~ G UTY LEItK -
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~ ~ BooK 243 PACE ~.43 ~
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~ • , ' AC(1 F'urm 71.~;!
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