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HomeMy WebLinkAbout0146 Qeciarat~on of Domicil~ and Citiz~nship ~ . . ~ . ~ 354012 . ~ ~ ~ ro~ c~uc o~~c~curraovKr. ~ . . ST.. l_, l1G 1 E„_oOVi~'r~t. t'[~ottm~: Tlds b my deel~u'auoa ot Do~nietk aud Cit~ca~btp tn tbs st~?te ot ~'Iocids t6~e I~aaa~fag ttda da,p in ~ooordauee, aad in ~onl~~it,r Nith Settio~ 222.17. Flocida Statnta. - . ~ ~ . , t ~ra r~ a kn1 e~aidept ot =..~(tdKKl~ie__.~. aud I ~ 1 _ ~ i+esided at ~ ~ How~ws.I Aaw ebaafed aqp doaakils to aad am aed 6a~e beeo a booa Gde resideut v[ tbe Seate ot flocid~ sinos -i~~ 3 -*''r'~ -dy at ~ ~"/~7- . ~i~ . _ ~ ~ - ..1lZ4., a~d I reside at Tw9i/e.r ~~//ip~_~ ~P.-I - ' 18te'Nt ~tl NwitD~H _ ~'~.s't- ^I~,~.p.n.Q. ~1 e,~r~ ~4 _ ST. LUG 1 E Conncr. Fforida, . tC~y1 - aad thb ststeareat b to be taken as e~? dcdarattoa o[ dtl~sAShip. aetuat ksal residcace and domicile in ths 3tate oi Flocida. - IP iOR THE .rURPOSE- Of ENRO«fNG _ I-f iOR HOHESTEAO PURPOSES~ CMiLDREN IN SCHOOL~ PLEASE STATE ~f.EASE tHECK: THEIR NAMESt - . ~ j+o ~,~~~a ~ Q ~ ~ . . . s . - i ~ . ~ ~ . ,~~I ~ 4~ ~M'1T ~ ~ _ . - - . . ~~~t01MT g~'/ . ~taRtilE~l?IEO : ~ ~ . ~ ~ - s _ 354412 . ~ - _ . - ~ I. FUATHER CBIiTIFY thst I~1 r~~stes at m~ local ~ddresa wben the ngistratjon booi~s reopen, and complr aith sit other requir+ements oi a kgal e~esideot ot tbls State, . - . . ! 1 FURTHER tbst I bave no iateation to retnra to a~ forn~er domie~e, aad 1 iatead to remain in ~ ~ - . ~,~'t" ~ e ~P - ~ . _ ~T . L U C t E , Couaty. I ! t~'iyl . Florida. permapcati;. ' . ~ _ , ' ~ ~ - - . c ' . , ~ ~ ' ~ CiQ ~~''r~ t;s . ~ G~ • „ . - 7Y~~cGt ~ ~ ~ - S R Y J . ~ n 'n q ~ •,s . . -titi; n A- ~ . ~ G . ` x' . : _ ~ r~ . ~ ~ = i - : . . ,r ~ ~ . .~~7'' J.J _1~'1 _ -s~1;~' ~'•.~>'y~j t . . . - . ~ ~ ,fn ~ ti . ` t fi r~ ~ ' `t~t~~~~, ~ ••....,~,~t!~~.,~~~ tNa~w) ! 1. s ~ ~ ~~y~ ~ Swon~ to tad subseribed bctore me thts ~ d~~ ot 33 ~rSO ! . _ A.D.19.~~ 1 ~tOGER P01 TRAS. CL RK OF C IRCUI T COl~2T - ST. LUG 1 E COUNTY, f LOt21 UA • ~ ~ eY: . - - . BPU LERK • - ` 6~K~:~71G i'kCE 1~ - ~ _ . Ai:~~t..~..,~~ -