HomeMy WebLinkAbout1401 ueciarat~on oT uomic~~e ana ~:~i~zensn~p
. . 3~6~~'
TO Tli~ CLBRK OF THE CIRCUIT COUAT, •
ST. LUG 1 E ~;pU~y. ~,p~p~:
Tbts ts r»,y declantlon o! Domie~7e and Citiuaship in the State ot Florida that 1 sm Gltna this da~? io aoootdsace. and in
~oatormity with Saetioa 222.17. Florida St~tut~s. ,
I was to~mer s legal resident ot - O „~j~{ ~a~i'~Gf~ and I
tGt~r?) l8tatd
~s~ea.t..._,Lp2 ,vv r~ J.~ '~Jf.- xo+.eyer. T ua~e ~haagea u~? ao~ls to
(StrNt aed Nye~b~rl -
aad +ua and bave been a boaa Cede restdeat ot ttu State ot Fforida sinea ~ da,~r ct
19~~ aad I nside at Z- ~
(8tra~t ~d NamA~rl
- ST. LIIC i E Ca,,,tr.
cae,~
and this statement is b be take~ u my declaratioa of dtiunship. ~ctual kgal reaidenoe aad domieile ia tha State of Florida.
I f fOR THE PURPOSE Of ENROLI ING I P fOR 110HESTEAD -PURPOSES~
CHiI[1REN IN SCHOOI~ PLEASE STATE PLEASE CHECKS ~
THE~IR NAMES.
. r
~ . 316~~'
_ lY~ ~ ~,G;- iT~p ~ R
~ Clt~sx~E ~ "`r~tA~= T^
w REI;nRD CI~CU11 CO~IRT
~ ?'fR~FiE01~~
~ 8 ~ ~ ~M'TS
. -
~
I FURTHER CERTIFY that I will register ~?t my local address when the registntion booka reopen. and comply with all
other requirements of a legal residenl of this State.
I FURTHE~ CERTIFY that I have no intention to returp to my former domici'te, and I i: tend to remain ia .
~ , ~ ST . L Ut 1 E~ . County.
«r1 .
Ftorida. perman~nti; . ~
.
~
. - • ,
't., • " ? ^
_ - i»~
. - . ` _ / 2. ~ ~z ~tlv r 1 ~r 1 Z
(Nams)
tAddew~)
Sworn to and subscribed before me this dsy of ~
A.D.19 / J - ~
~
ROGER POI TRAS, CLERK OF C IRCUI T GOU2S
ST. Ll1C COUNTY, FLORIDA
BY: ~~-lc_~ Co a~_~~~
~PUTY LERK
BopK 243 PAGE 1401 ~
_ - ~co F~~, T~-zz
~~~T-~ -
I se, i -
~