HomeMy WebLinkAbout0779 ' Declaration of Damicile and Citizenship ~
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TO THE CLERK OF THE CIRCUIT COURT.
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ST. LUC i E ~p~y. ~,p~;
• 'Tfiis ls m~? deeluatioa ot Donakils and Citisee~tbip ia the Stat~ of Fbrida tbat I am Wir~ this dq? ia aoeo~danos. and in
eontocmicy witb See~ioa 222.~7. Fbrida Sacu~ss. -
I~rasto~akgalreaideatot ~vn~T/irCi~N J'Tia-T~m~ _ lY~w YoR~~ aAdI
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resided at N 7' ~6?rn~ p T T /l~ Ho~revee. I haw elsanged my domieile to
(StrMt ~ed N~) ~
aad am aad luve beeA a boaa Clde resjdent ot tbe State ot Fbrida since ~i d~' ~
Gt"~Gi~iy-~L-vt , and I e~eside at ~ S v R h't 7C L/~ /Y L
(8en~i aed N~m~
/~o~ 7 S T. v c ~ 4^' , ST. LUG I E ~,,,~y,
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aad thb atatement is to be taken as mr dec4ratioa ot eitizeaship. actwl kgal resideace and domia7e ia tl~e State oi Flaida.
If FOR THE PURPOSE OP ENROLLING If fOR HOMESTEAO PURPOSESi
CNILDREM IN SC1i001~ PLEJISE STATE PLEASE CHECK: ~
THE1R NAMES:
, FILEQ ANO RECOR06~
~T. ~uciE COUNtr f~~.
RocEa ro~r~~s
' ClERK CIRCUIT COURT
RECORD YERIfIF~...~....---
~ ~ Ja+~ 1B 4 ?s PM'1z
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I FURTHER CERTIFY that I ~n71 ngister at mr loeal address ~?hen tt~ regiitration books reopea. sad tomplr ~vith all
other requirements of a kgal resident of this State.
I FUIiTNE~ CERTIFY that I hsve ao intention to return to tny former doauieik. and I iatend to remain in
• ST . L u c ~ e , councy, '
(CSt~) . _ i
Fbrida. permsnenci~ . ;
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Sworn to ~nd subxribed beton me this day oi
. A.D.19,Z7-,
GER I A CLERK OF CIRCUIT GOU2T
ST. LUG 1 E COUNTY, f LOR 1 OA •
BY: ~
. EPU IERK Q R ~E .
goox
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ACO Form 71 22