HomeMy WebLinkAbout1085 Declaration ot vomic~ie anq c:ittzensn~p
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TO THE CI.ERK OF THE CIRCUIT OOURT.
ST,~ LUG 1 E apUNTx. FI,p1~pA:
This ts mp daclaeatioe ot Dornkils and Cltt:enaAip in ttie Stats ot F'loetd+? that I ua til~ this d~r iA aoeoedaaee. ~d ia '
~aatoemitp wlth Section 222.17. F'1orld~ Statu . ~
l .
I was to~ a legal resident ot , sad I
, I i i8tat~
resided at ~"t~ Ho~rever. I luve ebaaaed m,~? domicile to
(BtrNt ~ed Nowo~rl •
and am and luve beea a bona Gde nsideat ot the State ot FforWa sloee ~ ~ da~? ot
~~r
19 ~ aad I =de at SL~( ~~J ~~~r s-
? (8tewt ud Nwo~rl
~¢/1 t ST. LUC 1 E Couacr. Floriaa.
(Cty1
and tAis statement b to bs takea as m~r deetaration of dtiuaship. actw?l lessl e+eaidenos aud do~eic~7e la the 3tste ot Flo~ida.
IF fOR THE PURPOSE OP ENROLLING IP POR HOMESTEAD PURPOSES~
CNILOREN IN SCHOOI.~ PLEASE STATE P~EASE CHECK: ~
THE R NAMES:
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j,j4L A[~ ~ NEC R p
J , ~G~Y11~4 ~Z - iT. ~~Qf ~aP~ T11~;
~A. 1~.
~ RFQOhA VEP~%t~0
OOU.~:
-rn c-f-~~.. 8a ~ 9 ~9 AM'15 -
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I FUR1'~iER CEBTIFY tbat I will register at my loca! address when the registratioa books reopen, u~d comply ~ritb aU
otber requirements ot a legal resident ot thi~ State. ~
I RT R CEItTIFY tluet I hav o intention to return to my former domici7e. and I intend to remain ia .
ST. LUC 1 E , ~~A=y~
- (Ck~l
rida. pernnanenti; . ~
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Swcir~~~ s~!e
~~efora ~ne this day of ~
r~r~''
L ~ A.D. ~8 ~ ~ - ~
- sr,~{~!~l~st~4 . ; , :
ROGE~'~ ,Qt TRAS, CLERK OF C 1RGU1 T COURT
ST. L lJG 1 E COUNTY, F L OR t OA ~ 3
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BY:
EP TY LERK
~ soox243 PA~10~
AGO Furm 71 22
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