HomeMy WebLinkAbout0618 Dectaratior~ ot uomici~e ~~~u ~~'ilZ~ifS~i~N
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TO T11E CLERK OF' TlIE CIRCUIT COURT, i
, ST'. lUC 1 E _.COUNTY~ E'i.ORIDA: ~ , i
ThV b mr deel~ratlon o~ DomicUe ~nd Citlzenahip in tha 6tate ot F'lohda that I am Gling tAis day ia acevrdartce. tnd ie
cantonaitr aith Sectlon 22Z.17. Florid~ Statute~. •
I wa ~o~ a legd t~aIdent ot ~E' ~/1.q~/ ~ ~ _,C,-~~is~_!~,_,_ , ae~d I • .
ltxt~! 18tat~1
ro~ld~d ~t ~ ~ S~ - - Howerer. I h~vs ehanged eny domieile to
(8tis~t ~sd Num~l •
end ~sa aad lu~v~ been a bona fide t~esideat o~ ths State o! Florid~ aiace daj ot
. ~~rl~$el2 ' ' ~ 19~ aod I re~id~ at 3r~6 _ ~ < ~rrt~-u~.~
(Bw~t ~ed N~mb~r1
c/~~r ~~r~ , , ST. LUG I E Count~. Ftorida,
ICtyl
sad thts ~tatemeat is to be Wcea a~ mr deelaratioa ot eitisenahip.. aetud legal reudance and domicite in the State oI Florida.
Ii POR THE PURPOSE OF EMROtItNG Ir /'OR HOHESTEAO PURPOSES~ ~
CNILbREN IN SCHOOL~ PLEASE STATE ?IEASE CHECK:
THEIR NANESt x t
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LUC1E CQtINTrR~~~ '
RGCFR POITRA~ `
CLERK CifiCU~T CO RT
RFCORO VEc'.r~FO
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I FURT~TER CERTIFY that I will reRister at my local addre» when the registration book~ reopen. and•comply rvith all
other requiremenb o[ a Icgal resident ot this State. _
I FURTHEZ CERTIFY thst I have no int~ntion to retura to my [ormer domicile. and I inte~d to remnin in ;
' fc(?T ~iE/l~f=~ s ~ ST . LUC 1 E .County, ~
(Clty! .
Ftortda. permancnci;.
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6worn lo ~nd ~uburibod beforo mo thi~ % day of ~~/c'T /~/E/~~E ~ /Gr~~Til' 33 ~!S c~ _ ~
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~`o~.~ .NOTARy~ ;°y= .
PUBLtC • =
ST. LUGl,;E COUNTY, Fl.OR1UA N' OFFICIAL
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BY: , . ~ = ~ .
• '••~~FC OR10~ a+?~ ~ wu~MESOH. .
~''~~~~~~~~~n~~?~~~ NOTAP.Y PUBI~ STATE OF FLORIQII AT U1Rl~
~ ° h~47 ~~E 618 . MY COMMISSIOt~ EXPIRES W1RCH 31. 1918. - ~
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