HomeMy WebLinkAbout0939 Deciaratian of Domicile and C~tizenshep
7~0 TtIE CLERK OF TlIE CIRCUIT COURT, •
ST. Ll1C 1 E__________apUtv7'y, FI,pItIp~: - .
Thb.~ my declaration ot Domkik and Cit~Zeaship ia the State ot F'brida that I am t'ib'ag tlw dqr Ia acoordaace. ud ta
tontormity with Sectioa P22.11~ Florida Statutes. -
~ I was tor~ a kgal resident of Ac_~,P~t Td c~ itl .!-L._~~*-' t d.~ •~od I
1~t7) ISt~t~1
r~sided at,~.~_T11~
11 ~~4~C ~a? Horrever. I bave chRnaed aa,y damicls to
(8er..t wd Nrnb.e?
and am and have been a bona Cide resideat of the State ot Fbrida aiaee ~ ~
.~'.e~ ~9.2~..,?~a ~,~~.t ,~1a R ' ~a;ra~.¢.v ~ - .
- . - • (8ttwt ~sd NumbKl
iF.e~ ST. LUC 1 E Councr. Florida.
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aad this atatement ts ~o be taRen as nq? dec4ntion of eiti~enship. actual kgal r~csideaae and domiu'le w tl~e Stste of Flo~ida.
IF F'OR THE PURPOSE Of ENROLIING ~ IF FOR HOMESTEAD PURPOSES~
CNIIOREN IN SCHOOL~ PIEASE STATE PLEASE CHECK: ~
T EIR NAMES: .
~
_
~.C~iSTl~l/~ ~i9.eiF ~J~CD~' ~~~i ~ht: ~~CD~DED
~~•~UCI~ r'}LlMTr fU.
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' Pt.~RK „'~:";J~T COURt
_ arrt)R7 Yi ci it:[i '
Ats 19 k' PM'76
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I RUBTHER CERTIFY that I wi11 registcr et ray lowi addrest when the registration books reopea, aad tomply rvitb all
other requirements o[ a legal resideat of this State. ~
I FURTH~y
~ CERTIFY thst 1 have no intention to return to my former domica7e. and I intend to remsin ia
~ r'i E.~L~ ~ S T_ L U C 1 E . County.
(Gty) . ,
Florida. pcrmancnti; . - ~
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a ~ ~/J~l~ IN~ms) ~
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Sworn to and subscribed befoee me lhis day oi ~T, ~,ee€_ ~,q . ,y„3 yC~
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~ A.D.19. %6
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. ROC~ER-_P{~,~TR`~i~S.'•.~~.~~C: OF C 1RGU I T COtI2T ~
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ST; :"1~~ I E GOUNT3~y #''LOEt 1 UA /
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'-y;; • :S s : ,~l~t : EPUTY LERK ~i-
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