HomeMy WebLinkAbout2133 ` • • r • • ! /
~eciaration of Dom~c~le and C~tizensh~p ~
. ' ~ 318$~8
TO THE CLERK OF THE GIRCUIT COURT. • .
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STs lUC I E apv~y. ~,p~A: •
~ TAis is my decLratbn ot Domitile and Citi~sasbtp iA the State ot F'losid~ that I ant filtag tAts dy? ia aecoR+danos. and in
eoatoemity rrith Seetioa ?22.1T. F'locida Statute~.
I was larme~ a ksal r+esident ot ~ f!~ ~ ~ aod I .
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. lCiq?1 181at~1
resMed at n+ - Hawever. I hsve cban~ed my do~aicile to
(Strsd asd Nw~Mr) ~
and am aad havs beea a boaa fide restdeat oi t1~e State ot Fbrida sinos Q~ ot
i~~ and I restde ~t
l tf ~ S. LUG I Ess...s~aN~ ~ v~- #/4~
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and tAis sUteu~ent is to be takea as an~ deelantlon ot citir~nship. actual kgal residence and domie~e ia ths State at Florida.
If i0R THE PURPOSE OF ENROL~tNG IF i0R NOMESTEAD PURPOSES~
CHItOREN IN SCHOOI~ P~EASE STATE PLEASE CHECK: ~
THEiR_ N MES: s
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318~3~8
I F1JRTIIER CERTIFY that I an11 register at my local address wnea the registratioa booi~s reopen, tnd oomply with all
other requirements of a legal resident of t6is State.
I FUB ~ CE thst ~ have no intention to return to my tormer domicile. and I in~ead to remain in
v..-C~-~c./ $T . UC 1 E County.
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Florida. pcrmanea~i; . -
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- tNam~i
(Addnn) ~
Sworn to and subscribed bcforc n~e this f~- day ot ~
_ ~ ~ ~ . n.n. ~a 7~
ROGER P01 TRAS, CLERK OF C 1RCU1 T GOURT
~T. Lt1C I E COUNTY, FLOR 1 A
8Y: ~
EPUTY LERK
• 6G~!!~~ FACE~~~ ~
- AGO ~orm 71-71
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