HomeMy WebLinkAbout0168 ~~;c~~rc~j~vij ~ V~i~1lClle ~il~l V~r~~~:n~rj~~,i ,
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TO THE Ci.kRK OF THE CIRCUiT COURT.
S~ 1 E COUNTX. FIARIDAt
Thts ia mr decl~ration oI Domlcile aad Cttia~aship ta the State oi Ftorida t!u?t 1 am qins ihis dyr in aeeosdsneo. and in .
coalonaiqr with Section 222.17, Fiorida Statutes. ;
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I wu torm~rl • kg~l rc~idcnt oi ~a' _ ~ p~4 -aad I •
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residcd at ~/~~l et.~.~~...~~~~.Q - However. I bave ebaagcd my domieilo eo
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sod am ~nd havo bccn i bona iid~ s~sidcnt of tha Stato ot Fbrida since l ~ ~Y ~
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(8trat ~wd Nwa 1 , _
' ~~l~` ~e~.~~l. ~ ST. lUC 1 E County.I~'for;da.
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u~d this atetcment is to bc talccn as mr deciantioa of chiscnshjp, actual k~l residencc ~and domie~c in lhe State ot Florida.
~P FOR TH£ PURPOSE Of EkROLLING - ~f POR HOHESTEA~ PURPOSES~
CHIIOREN !N SCHOOL~ P~EASE S?ATE PLEJISE CNECK: ~
THEIR NAMESt
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_ . =~~0 ARD RECQRp~ -
_ ~!E COYNTI' F-~
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I F'URT2IER GERTIFY that I will regi.ater al my locaJ address wt?en the registntion baolc~ r~c?~n, nncl comp4y ~iih a!4
othcr requircments o[ a Icgal resident oi this State. .
~ I FURTIiE:i CERTIFY~at I avc no int~ntion to return to my lormer domicile. and I intcnd to remain in
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Florida. pcrmanemi; . ' ~
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:f~+o~~~3 subscsi '}n~ Sibt$ro mo thi9 d~?y ot
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RO('~,,~F;'~~~ '~R~,~4~~ CLERK OF C IRCUI T COU2T -
ST. L l~ 1~ COUNTY, F I.OR 1 UA ~
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~ 600K 243 PACE ~UQ
• AGQ F'nnn 71
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