HomeMy WebLinkAbout0061 ~ Decl~rat~an of Qomicil~ ~nd Gitiz~~shi~
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TO THE C[.BRK Ob' TtiE: CIRCUIT COUAT~
, ST. Ll1C 1 E ~pUN't'y. F'I,pRIDA: ~ '
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This b a~y declaraiton ot Domtclle and Citlteruhip in tbe Stats ot Fiotida that I am GUng tAis dq~? ta ~?ooordance, u~d in
eorrforrattr +vith Scetion 222.17. Florida Statutes.
I waa t~ a kgat resideat ot ~~~L~_ ~A R 1~ ~ ~ N~ ~ i
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ce~ded at ~ 1`'n1 C_o u R"f , Noaever. I have elu~nged a~r domieik to
ts~+Mt ud Num~url . .
and sm and have 6~ea a boaa Cde seaideat oi the Stato ot Florjda siace 1'1 dar o!
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ut~ ~ -1~,~., sad t castde ac ~ b'1 ~~~~nos_ A ~ e:v» P_ .
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-~,•~C - Luu e. ST. Ll1G I E CouAtr. Florida.
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' ~ U?is stalemeot G to be takee u my declaratioa ot cItiaen~hip. actusl legal rssldencc and domicile in t6e State ot Florida.
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If POR THE PVRPOSE OP ENROCIING , IF fOR HOMESTEAD PURPOSES~ .
CHt1.aREN IN SCN00t~ PIEASE STATE PI.EASE CHECK: ~
~ THEIR NAMES2
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I FURT~iER CER1'IFY that I w~l register at my local address rvhen t6e registration books reopea, and comptr with all
other requiremeab oi a kgal resident of this State. -
I FtJRTHEZ CERTIF`Y that I fiave ao inttntion to nturn to m[ormer domicile, and I 1[iLChd t0 remain in -
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~ County.
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Fiorida. permaneati; . -
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Sworn~to and a~ , cribed belore me thi~ day ot ~.~~v~ 1' l 1~
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~ ~ A.D. ~9J7
~tOGER P01'LRAS, CL~RK OF G IRCU! T COUtT
ST. LtJG i E COUNTY f LOR t UA • ;
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9Ys - ~ . ~ , ~ .
. E P U T Y L~ R it : B~K ~ ~ fir PACE .
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