HomeMy WebLinkAbout0979 Declaration of Domicile and Ci~izenship
'1~0 TlIE CI.ERK OF TI IE C1ItCU1'i' OOURT.
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ST. L UC 1 E ~,p~DA:
'!1d Is my decla~atae d[)o~ic~M ~nd CitwASAip in tM Stat~ ot F1or~ds tl~at I aw Win~ this da~ i~ ~ecordane~. and in
e~sf~twit~ witA S~ctioa ::w.t7. F1or~da Stat~te~.
t~ru mer! • kfal tc~dsat of wd 1
K~l~f I~t~t~l
n~d at 1~ 1 .1 ~ 1+~ t~. :l - Hrwe~er. I lu~~ eAui~ed mr dorauik to
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tiu~..~ N.~M.1
ud aia aad Mv~ eera a Sona [id~ res~deat of tAe Stat~ o! Flonda unc~ aq ol
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~ ST . L UG I E Councy. Florsd..
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ud tbb st~temeat is to Oe taltee as mr dcdaratae d dtis~tasA~p. ~etwl ksa! Rsidene~ and ~omktle iA tM ~t~te ot Flonda.
I'OR TME IUROOS[ O~ [NROLIING I~ /OR NOMESIEA~ PURPOS[S~
(NILDREN IN SCNOOI~ ?LEASE STATE ?~[AS[ CHECK: ~
TMCIR NAMES:
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Auc ~ y ?t 11 t'h ' 7b
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' 1 P1IRTIIt:R CE:RTiFY tAat 1 wi11 r~R~eter at my bcal addr~~s when tAe r~Kistnt~on books reopen, and comply with aU
ott?tr reQuiremrnts o( a kgal rcsid~•nt ot lhis St~te.
1 t'UF{TNE::~ CE:IiTIE'1' that 1 have no ~ntrotwn to return to my formrr dom~c~le, and 1 intend to r.•m~~n ~o
` ' ¦ ~ $ T , ~._U C . County.
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i~btida, permanrnci, .
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(AldfiM)
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Sworn toand suhxrit?rd b.~for~ me th~~ ~ 1~` dar ol
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`'=':1 ~ . A.T). 19
_ R_QGER QOI~RAS,,lLI_ERK nf C iRf.Ul T COlJ~2T
- ST. LIJC I E COUNTY, F LO~t i UA
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