HomeMy WebLinkAbout1345 uec~arat~on at uomiciie ana c;~trzensn~p ~
TO TH6 CGERK OF THE CIRCUIT COUAT. 316~48
ST. LUC 1 E ap~y. gT,pRIpA:
T6L b mr decluation ot Donnicile and Citisenshtp ia the State ot F1orlda that I am t~7ing thts da,p ia ~ooordanos. sad ia
oo~ntormity ~ritA &ctioa 222.17. Florida Statutes.
I wu t~ a legal resideat ot 1 LC G~A,l~ 4~ f'~~~U OG~'t~ ud I
restded at 7~ ~i ~ ~ I/~°. G+~ L( ~ However. I have ehu?ga! aa~? domicyle to
ISernt aed Nu~~) ~
aAd am aad havs been a bona Gde resideat ot ihe 3t~?ts of Florida siace ds~r ot
Gt ~ lg_ / V~ and I e~eside st~~oa~t• ~~i~k'~s ~~~~~1~'~.°G`f'~A~C ~!!NO/s~(-
~ OP- os~ !'~.Lf C/,lr° ST. lUG 1 E~caedNnmeK~ Count~. Florida.
tQiql
and this statemea! Is to be taken as mp deel~rition of eitizecuhip. artud kgal resideaee and domidle ia the State ot Fl~ida.
IF FOR TNE PURPOSE Oi ENROILING IF FOR iIONESTEAD PURPOSES~
CHILDREN IN SCHOOL~ P~EASE STATE ~ P~EASE CHECK: ~
THEIR NAMES: ~
FIlEO a~~ RECQRpEO
ET.l1iC~~ ~OtINTY FtA,
- RQCER POttRAS
CLERK C~~COtT COURT `
P.ECORO'~ER~FIED
- -
~ SE~` 8 II SS ~!!'15
ass~48 ~
~ ~
I FURTHER CERTIFY that I wiU register at my bcal nddress when lhe regi.+tration books reopen. and comply wiih all
other requirements of a Iegal resident ot this State.
I FUR~E~ CERTIF'Y that ~~ve iatention to return b my formcr domicile. and 1 intcnd to remsin ia
_ OLti~ csf llG[ .~~L~. ~ ST . L UC i E Couoty.
lGt~) .
Fbrida. permanenti; .
,~~~~...~;~+f~ ~ - •
/ -
/y+,j• . /
, :...V.
~ . ~•i/ ' - e(
~C ` ~y,~~~ •
" G•• ~ %
:r,- .~~~Q;~ : .
. ~ ~ . - Q.~~~'~-
N . ~ ` / :
. - ti$~:'~! y . • ~
. • • ~ i{a-. J:: ~
',I ~ ~ ~~f~~t~~~~~o .
. i•, -~C ; ` G ~ ~ +me)
~i'~~ /~C~L~~
Sworn to and s 'bed be[ore me lh~ " dsy of ~
~ . A.D.19 7~
ROGER P01 TRAS, CLERK OF C IRCUI T C4U2T
ST. LUGlE GOUNTY, F tUA
BY: ` ~
EP Y LERK
~ go~~~243 P~~~1345
~co ~om, ~1-zs
~ . --,Y - , a ~ _ ~ • _
~ - -
`
zs