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HomeMy WebLinkAbout2377 . . / ~ ~ Declaration of Domicile and Citizenship ~ ~ TO TH~ CLERK OF THE CIRCUIT COUAT. . ST. LUC 1 E apU~. ~,p~p~: . h,o . Tb4 M°o~`~d~ieluation ot Doenkile and C1ti~enshtp In tIM 8tats ot ~7osid~ tba~t'aw SW~ this dy? tn aoeoedanos. aad tn eoafo~aAit~ Mit~ 8ectioa 222.iT. F'lorida 8tatu~. ~,Iwo er~e a kgai rs~ideat a~ ~~d -s ~S ~ o~ c7 ~ , J wd 7G/o- ICI~,?1 (ee~t~ raided at 14'`a ~ 4~ /Gc = - No~wwe~.~sva cban~d ~ay~.domia'~e to 4 lateMt aid N~OaI - ~~iR iDa INY~ ~11 ~ bOM ~!'~OII~ OE ZIIO S~~ OI I'~0l~t f~OOS ~ ~ 0( Ol'so ~4s~? ~d/' ~ 19 ~ `~aad~resWe at j ~ /I~es~,rcd ~•s~•~ ~~i~s~.., c~S ~ ST. lUG i E~••+rr..e.r? Count~. FforWa. iQb) _ and tl~b statsment is to be Wcen u°y~Jrdaeluatian at eitisenship. adwi legal residena and domicile ia tbe 3tste of Florida. If POR THE PURPOSE OP ENROI.LtNG IF fOR HOMESTEIID PURPOSE f CHIIOREN IN StHOOL~ PLEASE STATE PLEASE CHECKS ~ THEIR NAMES: ' lLED Rri:. ?'t~U~~M • Clju~~ i;OU fcG+JG~ P'tT~l~s ~ e{.~~''.t '~.::(.i~i,' ~Q t. ~ • 4=cc~r vi~~ =rf~ ~AT I~on 1~1 Z l~ PM'?5 ~ - . # ~FURTHER CERTIFY that I~n71 register at p~loeal address whelf tIlQ [EglSuitlOD b00ks !!O~lA. and oomply ~vith all ~ otber requL~ements of a kgal eesideat of thi~ S4te. ~ e,ir • «/r € I Ft1ATHER CERTIFY ~~s have no intrntion to retura to ~ fonaer domieile. and~ Iatend to nmaia in T~a~ ~s d~~, , /ST. uc ~ ¢ .co~pcy. E ` (Ok~) . ~ Florids. Permanentl; . ~ - ~ ~ ~ ~ ~ ~ ~ ~ ? S C ~ ~l~a~~~n G- /Poorfe ~ ~ - ~ > > ~ a i C~~~ ; ~ ~d~~iC~.T `~ilO /J C~ ~ " ~ 4 ~ a ' G i ~i~C~~'~" ~ °i c~c~ ~ : w.~~Sworo a~b9eribed before ms this ~,L~ day of 6'~~ ~ y ~ . E~w'b r. ~ A.D.19 ~ ~ ` ,1~(~~uZ~~ . 7S_ ~ / • ^ , • . ~ ~ AS CLERK OF C IRCUI T GOl~2T "'r. ~w ~t~ ~ s`~. ~uc i E couNnr, F~o~ ~,oA _ ~ BY: , , ~ ~ E PUTY LERK ' ; . ~ , Bo~x 2~5 ~~2374 ~ f ,r, E : f',.. ^ ~ - ,n - - - . . . ~ - , ~ ,u- _ ~~r ~v~~~ _