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HomeMy WebLinkAbout0738 Dec~aratian of Domicile and Citizenship . . . , ' ~ ~E~;ti ~ To ~ c~~uc oF r~ c~RCUrr oocrnr. . ST. lUC 1 E ap~. _ Zfir 1~ ~ d~elustk~ or [)oraiciM a~ Cit~~ is eb~ Stata ~ Fla~ida tlwi! l sM Wie~ Ws ~ 1~ ~~o~ds~a. a~d i~ eMlw~ity wit? S~etkr 2Z2.1'f. F{Kid~ Stat~s. ~ 1 1~ 1 n+e a le;s! r~side~t ~t A~ f~ ~,y,~, ~ f,p a~d t ' d IC~1f 1Nw1 rMld~d ~t ~ r i:'~ /1'~ ~-`Ai~ - Hrwr~. I 1sw dan~d ~ap doaueife to {~Y~l ~ N~MrI s~d ~s a~d luw bMa a b~oas Gde eead~ot e/ tM Stae~ a( F'lorid~ siaa ~ i~ et ^ ~ 1 ' /-y~,P~ - ~ r ~ L ~ ~1'" r - IS~~,,,~~ Yd T ~ ~ - " + ' 4 W NM~f~ . ~ ST. lUC 1 E co~.e~. ~1o,;e,. 1aV~ ~d 14i.,tacemeoc b a be tak~e a or decl.ratioa ot cic~uns~ip. ~et~a1 k~al re.id.aa sad domic;le i. cl~. 3tate d F'ioreda. I/ ~OR TME ~UR?OS[ 0~ ENROIIiNG I/' ~OR MOMEST[AO PUR~OSES~ CMIIORtN IN SCMOOI~ PL[ASE STATE Sl[AS[ CMECK: ~ TM[IR NANES2 ~ ~ ~ , ~ , J„ ~ ~ / 1 • ~l ~ , ~ < • ~ _ l/ f. r ~ S~ t(~^,; ,"'t,~/1' ~ • R . ~ ^ ~ p4 J ` • '~:uA . ~IfC Il 1 34 P , ~ M16 1 FURT}If.R CFRTIFY that 1 w~U re~ster at my local ~ddres~ w1~en ti~e rcg?strataa books reopen. •nd eomplr .ntA ~U ol?et requirements o( a kgal fes~dent o( thu State. 1 FUHTt1EZ~F.RTIFY that 1 Aave no intcntion to retura ta en former dom~cik, s~?d I intend to rcma~n ~e ~T . ut 1 E . Ca,acy. ; 1~~! s ~ Florida, permanenti, . f ~ ~ ~ E e EpF G ~ C ~`c Y ~ ~ ? ~ ~ . ~ ~ : ` ' ~ ~ . i~ , • r" ~ / - li~l ~ ' ~:f,r^ ~ , . . ~ IAMe~I Sw~e l~ ~~d sutntribcd brlore me this ,_,...y_ day o( ~ - .~.r.: ~ ' " ~ A.D. I9 7 - L gQ~ R aS,.,_C~,ERK OF Ci~CU~T COU2T ~ ~ ST . L UG I E COVNTY, F L OF21 UA ~ ~ BYf ` . C`1` - 3 [~utY IERK ~ ~r ~ , ' ~ V~ F71i~t ~ _ : r_ ~ - _ - _ _ t: