HomeMy WebLinkAbout0297 . ~ i
D~laration of Domicile and Citiz~nship
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To~c~coF~cn~curroounr. 32~'85 ~
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ST. LUC 1 E apvt~rt~r. Ft,otu~A: - • ;
Thi. r ay a.etar.tbn o[ Doaikil..na clt~o.Mip ~n ui. stat~. ot fioda. elut t.aa mio~ t1~. ay? l~ .eeora.sc.. .oa ia ~ ;
aoe~o~aiipr witA 8setioa 2?'1.17. ~'loc~a Statnt~s. ~
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I I~as t c r a k~al rssideat a~ -
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r~~idsd at ~ 3 A- ~~~E c,/ STi - Ho~w~av~r. I ban eLae=ed nq? do~e w ,
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~ad am aad haw be~n a boo~ tjd~ ra~ent ot the Stat~ at I~'lo:ids dna ~ .
v ' - il~~aed I r«id~ at ~ _ ~ G ~ s ~ 7'•
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/aD S T 1? u C~ rE.. _ ST. LUG 1 E ~ti.
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aad this statament b to b~ taken as a~ deelaratioa ot dtl~enship. adual kaal rssidseo~ aad domie~is ia tM 84te d Flocida. ~
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If FOR THE PURPOSE Oi ElIRO~LING IP FOR NOMESTEAO PURPOSES~
CMIIOREN IN SCHOQ~~ PIEASE STATE rLEA3E CHECK: ~
THEIR NAME3:
F+LEO AMO REcpR
sT LUCIE QOUNT1r ~
- - ~ CL RKCC
RCUIt COURT Q( .
RECORD VERIFlEO~'~ p,
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i I FIJRTHER CEBTIFY that I w~l register st m~ local address w6en tl~e ngistratioo booics r~eopea and complp w?ith all
other requirements ot s kgal resideat of tluw State.
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! I FUI~1'HEgt C~RTTF'Y tl~st I have no iatieotion to return to m iora~er domicik. snd I iatend to reanin in ~
i /~O R.T' S T, P~/ ~ _ ~T . L U C 1 E , County.
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~ Fbcida. pernunencl; . '
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a~spble,ribed betore me thlt day oi D/~~T .STi U Pr/•~ ~ 3 y~
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C ERK OF CIRCUIT COl~2T
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~ ' t1~. ~`GOUNTY, f LOR t 0A .
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EPUTY LERK
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Ar~ Form 71 2..'' •
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