HomeMy WebLinkAbout0815 Declaration ~f Domicile and Citiienship ~ ~
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TOTEI~ CLEAK OFTHE CIRCUITOOURT,
_ ST. LIJC I E~COUNTY. FI.oAIDA:
Thls b m~r deelscatlon oi Do~aieile aad Citiseasl~p ta tl~e State ot Fbeida that I am Glina thts da~r ia aaa~danas. and in
~oafon~ty ~vitb Seetioa 2~.17, Florid~ StatuLes. .
• I ~ras form~erl,~ a legal cbsident ot ~ , ~ aad I
. ~ IC~' 18taW
t+ssided at - -Q= However. I havs
18ee.~t add Nuob.rl _ ~~8~ ~J' domieiie to
and am and bave been a bau Gde resideat ot Lhe Stste af Florlda sines d~r at
19~..'`~iod I reside at _ c~ /!I~_O ~ v i~1C~;
~5,~~ _ ~ ~ ST. lUG 1 Es~.c..aN~i
~ ,n ~ Count~. Flo:ids.
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aDd Llll! sL~L!!lIIC11~ 1! LO ~ WIO11 is f~ dltlir~LJO~ Of tIL1iQAlII~. aetual kgal resideaca and domicile ia the 3tate ot Flarids. ~
if fOR THE PURPOSE Oi ENROLIING IF fOR HOMEStEAO PURPOSES~
CNILOREN IN SCHOOL~ P~EASE STATE PLEASE CHECK: ~ ~
THEIR NAMES:
FIL~L = i~ ~~y'v:~~
ST. ~t.,.; . ,~},YTY FED
Ri::.:-~ _-,r-~:$ U.
' CLF~K ~C~.'RT 1~ !
ac~~u,~ ; : ,
OEC I 3 i~ PH 'T5 ~
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321983 ~
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I FUR'1'HER CERTIFY that I will register at my tocal address when the registntion boolca reopea. and comply with all
other requirements of i legal resident ot this StaLe. #
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I FUBTHE~ CE FY Llut 1 have ao intention to return to my forme~ domicile, and I intend to remain ia :
_ --~',rfZ s~' , ST . L u C ~ E i
. County.
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Fbrida. permanenti; . '
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Sworn to and subscribed be[on me tAis _____L_ day ot , ~,~~,,v~ 3 3~~,Ij~~
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- , A.D.19_ ~S-~
ROGER P01 TRAS, GLERK OF C IRCUi T'CAC~~"'~; ~
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ST. L UG ! E GOUNTY, F ~OR 1 DA : • -
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AGO Porm 71 2'~
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