HomeMy WebLinkAbout0075 ` ~ - ' m' i! and Citiz~~shi ~
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TO THE CL~RK OF TlIE CIRCUIT COURT.
. ST ~IUC I E CpUM't~y. FLOtuOA:
Tbb b my d~elsration ot Doinietle aad Citizcnahip in the Stato o[ Fbrid~ that i aat Gltag thia day ~u aceordance. and ta
tonfosanity with S~ction 2~.17. Ftorid~ Statutea.
i~ra tormrrlY a kgal nsldcnt ot ~~...~~E ~ . aAd I
. (pt~? lstatN
re:ided at - Ho~revec. I Aave ebanged my doaaic~e to
~ • (Swat wd Numb~~) .
and am and have been ~ boaa Gdc reaident ot the St~te of Florid~ since ~~u d+y o~
~ 191'~.. and I res~de
at ~/e_ ~~~l1~_~v~ -
lStr~.t ssd N~mee~l
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' aad this statemeat t~ to be taken as my datsratioa oi eitizeaship~ aetua! kgal nsidenee and domie~7e in the Stato ot Flo~rida.
If i0R THE PURPOSE OF ENROL~ING . Ii FOR NOMESY£AO PilRPOSES~
CNILDREN IN SCHOOI~ PI.EASE STATE ~LEASE CNECKt ~
THEtR NAMES:
. l~1~llietCi. 1 F,~l~ p
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QiENCp~ECp
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_ - - - RECp~R~~~~ ~~RAS '
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fES js I s.~ G~~,.~..__
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I FURTHER CBRTIFY lhat I~1 register at mr toea! addc+esa whert the registratioa bodcs reopen. aad eomply wntfi all
other teqeirements o! a(egal tesiden! oi this State. }
~ t FURTIiE~ TIFY that I have ao intention to retura to m former domic~e. and I intead to remain in f
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Florids. permanenti;.
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Sworn to and subseribed betore me thi+ ~ day oi ~t G ~ e ~ ~~/4 ~ 3 y.~D
~ ~Ra~e~ty ~ A.D.191~ -
ROGFR P01 TRAS, CLERK OF C IRCUI T COU2T -
ST, LUC 1 E COUiV7Y, FLOR tUA ~
~ BY: .
_ , EPUTr x . ~I~ ~ PACE ~V
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