HomeMy WebLinkAbout0260 ' D~ct~r~ti~n c~f DQmi~ii~ ar~d Git~Zen~hi
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TO TIiE CLERK OR THE CUtCUIT COUAT. .
_ ST. LUC 1 E ap~y. ~,p~DA:
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T6b b my dectuatioa of Domieile ar~d Cit~sonahjp in tlie Stato ot ~'{orid~ thst I ~n GUag this da,p In a~aocdance. and in
eontormity wfth SettioA 222.17. Florida Statutes. ~
I wa t~e*~X a legal residcnt ot ~,~R~ !'~Q.T~ ~ • , ~ ' ~ad I •
f~~t~r~ • ts~.c.~
resided at ~lp~ l,._.__jdY~L~,~,!~~~.b~~_ - Ho~revee. T havo chanaed aqr domicile to ~
18tn~t uid Num~r? ~ ~ ~
aad am and have been ~ boaa Cdc ce~ident otthe Sta~te ot Florida sinee • • day ot
,
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~ ~ ..___~:10~. a~l I res~de at 3~ O / ~i ~
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tStn~t s~d N~r)
/'i ~e r~ L. ST . L UG I E Coup~r. ~foria.,
ry.
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' and tbis statemcat u to be taken as mp d~claration oi eitiz~nsbip. aetual kgd reaidenee u~d domicH~ in the State ot Florida.
Ii fOR 1'HE PURPOSE Of ERROLi.iyG ~F i0R HOMESTEAO PURPOSES~
CHILOREN fN SCltOOR~ PtEASE STA7E P~EASE CHECK: ~
TNEIR NAMES:
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a E~ ~o, R~s
AE~` v~R
~i~@ ~OURT
f~e il 12 a9 Py
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I FURTHER CERTJFY that I will register at my local address arhen the rcgistratioa books nopea. aad comply with all
other requiremenb ot a legal resident of this State.
CERTIF'Y that I have uo inteetion to nturn to my lormer domicile. and I iatend to remain in
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1` . I"i ~i~ C Q_ ST . L UC i E - Couaty.
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Sworn to snd subxribed betore mo lhia ~ day of ~
- ' ~ ~ ~ - . A.D.19.,.7r - -
ROGER P011RAS~, CLERK QF C IRGUI T COt~2T
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f ST. LUG1E COUNTY, FlOR1UA
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