HomeMy WebLinkAbout0169 ~~c~~ra~~~n o~ ~~mecite an~i ~~~i~~nsn~p _ ~
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TQ THE CL~;RK OF THE CIRCUIT COURT.
ST. Ll1C 1 E _('~UI~1'1"Y~ FLORIDA: .
Tl~s ts m~r dccl:n?tion ot Uomicife snd Citiscnship in tl~e St~to oi Florida that I am itiiag this dyr ia accordenco. and i~ .
eontoraaItY with Sectioa 222.17. Florid~ Statutes. ; '
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I was tormcrl ~ Icgal reaidcnt oi ' .
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rasjdcd at ~ Howevar,l have ehangcd my domicilo to
Isen~t ~d an~l ~o~
•dd am and b~?vc becn a bona fidc residont-ot tho St~ta of Florida sjnce M~. i:~3~' d~y ~
`a-g `1 " ---t S~( f~ 4,.,.~-} ( 'c~1' 012(1 ~ ' '
, f9~ ~iii! 1 res~de at 4_~
lStnst wd N berl
~J 1'~ '(1 S7. lUG 1 E County. Florid..
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and this statement is to be taken m~r declu~tioa of citiscaship. actual kg~l residenee snd dosnic.~e in tho Stat~ ot Florida.
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IF POR THE PURPOSE OF' ENROLLING - IP POR HONE57EA0 Pt1RPOSES~ j
CHlL~REN IN SCHOOI~ P~EASE 5TA7E P~EASE CHECK2 ~
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I FURT~IER CF;RTIFY tbat i wip rr.~;i~tcr al my loca4 address tYhca thr rcgisirtian br,~ks reo~x-n. fiiid tptlttrly ~vith all i
other rcquirements oi a lc6a1 resident of l!~is Stale.
1 FURTIIEZ RTIT'1' .that I have o in cntion ta returr~ to my formcr domicilc. and i intcnd to rcmain in
_ , SY L u c i E , c~u~ty,
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Florida. permancn~i; .
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Sworn lo nnd'L~31jt~}i~ied t?e(oro mo thi.g dny of -~~~S~
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RnGFR Pnl T AS,~GIFRK_nF G IRCUI T COUtT
5T. LlK i C COUNTY, F1.0(t 1,UA . '
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