HomeMy WebLinkAbout0027 ' s' ' ' nd Ci~iz~~shi ~
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TO TNB CLERK OF THE C[RCUIT OOURT, t~+~p,~ ~
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ST. lUC 1 E CpUN7'Y. t'I.oRtDA: ~
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• '!'ab ta mr deelantion of Domicile and Cit~cnal~ip in the 8tate ot Fbrid~ th~t,t ua filins thts dq~r ta ~ocord~~tee, ~ad in
tonfu~mitr with Satioa 2~.'.17. Flor'sda Statutes. .
I was formcrl • tegsl aident oi ~ ' ~ I
IC~V1 lSt~t~l
~t • HoMreret. I have cbaa6ed my domicilo to
l~~t u+d NnmMtl '
~e~d ua aad hava been a a fido rosidcat of the Stats ot Flosida siaee ~ . d~y ~
19~ snd I r~sfde a~ ~ ~
aad NumDeri
ST • Gountr. Fiorida, .
IGt~I
" and this statement ~S to ba taken~as my dee4ration ot dtiun~hip. actuai kgal resideaec ~nd domie;k Ia the State of Fbrida.
--If_ FOR THE PURPOSE Oi ENROLLING If iOR NOMESTEAO PURPOSES~
CMII~REN 1N SCH04L~ PlE11SE STIITE PLEASE CHECK: -
HEIR NAME • , _ -
.
E LEO AMpRf
CpROFO '
~ WCK 401JMTY~ LA.
RCCEA ~'pl
RfCOltO Y[~+ u~OtIRT
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ffe l6 - -t2 xa PH''~
- 35~817'
I FURTHER CERTIFY that I w~71 register at mr bca] address when the registntion books reopen. and complr with al! ~
other requirert?ents oi a legal residenl of lhis Sta!e.
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E= I FURTHE.t CERTIFY t}~t I have ao intrniion fo return to my tormer domicile, and I intend to remain ia
f: ' ~ $T . L U C 1 E . County.
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~ Florida. permar.rnti;.
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SM~otti to epd subscrit~d bcto~o me thu dey ot ~~~9
- A.D.19~~._...
ROGER P01 LRt~S CL~RK OF C{RCUI T COU~2T ~
ST. LUG 1 E GOUNTY, f lOR t UA •
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