HomeMy WebLinkAbout0543 ~ecEaratiar~ of Domicil~ and Citi~enship ,3;~;~~~.~
TO TIIE CLERK OF T}iE CIRCUIT COURT,
• ST. LUG I E COVNTY. I~'I.ORIDA:
This is my dcclantiea ot Domktle and Cltlzenship ta tbs State ot Florida tbnt 1 un G~a~ this d~r ia aooordance. ~nd ia
eontormitr ~rith Section 222.17. Florida Statutea. _ ~
and I
I was fo~ s kgal naident ot .^1 ~i5 R C t.l! O p~ ._~~!y[,~~/lSo .
~ / ((~lr) _ / (8tae~)
raided at ~~J -~O / Q(' i~ C~ f~~ Ql ' . However. I l~are e6anaed ~r domicele to
~se~..c.eax~e.~~ - ~ ct n~ILC
aud sm aad h~ve bcea a bona t~de naident ot tbs State ot Fiorida~since d+U~ ~
'
/o ~J~ri 3c: 2 y 19~_. and I nside st Q S• ~•.4I / N L A''~ l~o ~ C~
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GL T.S c, ST . L UG I E~••a N..e.~t Conncy F1or;da
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and this atdement is to be takea u my dee4ntion oi eitiunsbip. actual kgal residenee and domdeile in the State o[ F'lorida.
1F FOR THE PURPOSE Of ENROILING IF fOR HOMESTEAO PURPOSES~
CHILDREN IN SCHOOL~ PIEASE STATE _ PLEASE CHECK: r~(' ~
THEIR NANES: . - ~ ~
_ ~332~~,3
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~i.I~JCIF ::OJNtr~~A. ~
• =_.+'RAS
. ~ CLERt :.:tGJ:T :OURT
~fco~? ~ f~E[
~ tV 2.r1~ ~N '76 ~
I FiJRTHER CERTIFl' that I will register at my local address when the registratioa books reopen. uid compl~r writh aU -
Mher rcquirements of a legal resident of this State:
I FURTHE ERTIFY I hav no ibtention to return to mq former domieile. and I intend to remain in
' 4~ 9t ~ . ^ $T . L U C 1 E . Coi~nty.
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Fbrida, permar.emi~. ~
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f ' Sw~rn~to and subscribed brtore me this .J~ day od ,q~
B~~ T ~ T ~?i~C~! 1•
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f W~-~?ti.~ , _ ~
. A.D.19_ 7 G ~ ~E ~I~I~ F ~
ROGER PO i TRAS,~CLERK OF C I RCU 1 T COURT
ST. Ll1C 1 E COUNTY, f LC~R t UA -
Btr:
EP Y LERK .
~ n 1 eACE v~`t~i
~ ~ AC~~ F~,r~:, 71 :.T.
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