HomeMy WebLinkAbout0670 3 • . ~
' Deci~ration ofi Domicile and Citizenship
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TOTHE CLERK OF THE CIRCUIT GOURT. • '
ST. L UC 1 E OOUN'1'Y. FLOAtDA: .
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Thts b i,~? de~lantiop ot Domteile and Cttiuashi~ la tbe Staee d Florida tbat I am qla~ this dyr ia ~ccordaaee. sad in
~oatota~ity rviLA Sectioa 222.17~ Florida Statubs.
I~na t rmerl a kaal sesjdeat o~ ~ ~ aad I •
. tAes~ t~tn~
=esid~d at ~ 8o~rtver. I w cbanaed a~? domieile to
l~n~t a~d Nr~lwl •
ua aad lu~ve ~eea. boaa Gde resideat ~ the State a~ Ftorids sir~es 4 a~~..,._., day. ot
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19~. and I na,~ at ~ -
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SY'. LUC i E Councy. F'~ocida.
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aod tl~is state~neat b to bs taken a~ an~r dec4nUon oi dthensbip. adual kgal resideaee and domieile in tAs Stato o[ Florida.
I~ FOR THE PURPOSE Of ENROLLING IF iOR HOMESTEA~ PURPOSES~
tN1~~REN IN SCNOO~~ PLEASE STATE PLEIISE CNECK: ~-I
TNE IR NAMES: - 3~,~2Q j
~~RC~NINTY il~.
CLERK CIRCrotItT~Cp=URT
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- I FUEtTHER CER'PIFY that i~n7t registet at mp {aal address ~rbea the registration books reopea aud wmply ~vith aU -
otber requireaunts ~ a l~egal r~sideat ot tbis State. ~
I FURTHEZ CERTIFY thst I have ao iatention to retura to my former do~e. and I intend to remain in
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lt~y? . .
~'locida. Peraaanent~; .
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to i1~~ su~etibad betor+e me this ,.LL~_ da,~? ot "~~.lJ
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ROGER PU1 TRAS„ G~..ERK OF' C IRCUI T COU2T ~ ~
ST. LUG 1 E COUNTY, F e.OR ~ oa ~
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EPt1YY LERK
~ PACE 6~
600K
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