HomeMy WebLinkAbout0048 ' dec~~rafi~t~ a~ Glo~~c~ie ~nd Cit~zen~h~ip c~~ :
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TO TlIE C[.EBK OF THE CIRCUtT COUItT. i.
ST. lUG 1 E Cou~t, Ft.oRtDA:
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Tb1s b my declaration o[ Domicile and Citir.enship ta tba St~te ot Fbcida tMt j am Gling this dy? !a aceotdtacs. and in ~
coaformity with Sectioa 2~:.i7. Floctda Statute~. ~
I ~ru fo~m~~l ~ legal tcsldent ot ~=-x~~ ~d • `
~aadI
. I~trl ISua)
raided ~t p o:cver, I hsv~ ehan6ed mr domicile to ~
l3tn~t ~ud Numb~l . y- . ~ 71 .
and sm aed have beea a bona fida seside~t ot the State ot F'lorida sinee dyr ot
.
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. . ~9~. u~d I ce~ide at D ~ • ~ . ~
~ _.~e~.e,~e N~e. ~
1P~-`h ~ ti~~.:. __y_ - _
~ ST. LUC 1 E - County. Fiorid~, i
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ICIt71 . ,
' and thts st~temeat t~ to be taken as en,~r decbc~tioa of eitizenshig. aetual kga! sesidence and domieile In the Stato of Florid~. '
IF FOR TNE PURPOSE OF CNROLLtNG IF fOR HOHESTEAO PURPOSESi
CHILOREN IN SCHOOL~ PLEASE 3i'l11'E PLEASE CH£CK: ~
TH 1R NAMES: '
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F lE0 AN~ ' , '
• t~ ttIClE C 1~~ ~ ~
~ ROOER Mj1RAS :
v • , IIECORO YE11RF EO
COtM~•
_ F~e i6 1 23 PM'1~
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I FURTIiER CBRTIFY thit I~?ill registcr at mr local addresa when tite registral~n baoks reopen. and compty witi~ att
other requiremeai~ ot a legal resident oE tbis Stste.
I FURT}IE:t C TIFY that I h~a
?e no~ ~nttntion to teturn to my [ormer domicite. ~nd I intend to retruin in
' ~O-t~" S.~' c~Ls4.c,i. Y. l U C 1 E , Couaty.
lCit~) . ,
Fbrida, permanenti; . .
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Sworn to and sub~rribed bctoro mo thu dar ot ~9 ' tJ G 1 -C r i
. A.D. 29~7 - '2~ 'S s" 2...
R GER P41 AS CLERK OF C tRCUt T COU2T
ST. Lt1GiE COUNTY, F~ORtUA ~ •
~ BY s C~ , . .
. EP~TY ERK
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c~ ?6~ ~ 48
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