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HomeMy WebLinkAbout0333 . _w- . .~l'..s+-.. . . ~f . _..r,.... V ' Deciaration of Domicile and Citizenship ~ . ; . _ . `f ~ ~ • • ~~S 4 , _ , . - t TO TH~ Cz.EBK OF THB CIRCUTr COUAT. . ST ~.t1C 1 E OOVN'1'~t. FLORwI~ _ ~ - - . f 7'hts a mu? dsetarattoa ot Domieil~ and c~c~na~hip io th. StaU. a[ t'to~fda eaat I as 6~a~ tbis dyr ta acooedana. and ia 1 e~oeanitJ witb &Kttoa ~l8.1T. Flo~jda Statutu. ' • ~ ~~~/L[~C~ . ~ I ~r~s t~e a k~l r+ai~at o~ ~ - ~ i : - l~ ~ tald~d at ~ - No~r~vee. I Tu~w ebanged ayr doaa~ to ua Q ~ t~+~t aua Nw~Mrl ~ • aaa w aad 6aw baa a bau Gda r~ddtat oithe 8tatt ot~'foeida ~iaa _.__~Y~-. ~U? ~ ` _ i~..~az~a.,~ o . ~ ~ . ~a~..~ ..r.~ ` ST. lUC 1 E _ ~ tc~ - ' aad tbh statement h t,o be tskea a a~r dedssatbo ot dtizea~hip. actual kgal resideaee and domkile L~ tbs State ot Fbcids. t ~ ' "^u~'STEAO PURPOSESi --I F POR TNE ~URPOSE Oi ENRO« 1 NG s s : y~ CMILOREN IN SCN00~~ PLEASE ~TAtE ~~EASE CHECKS ~ _ _THE I R NAMES"t - _ _ _ _ _ _ _ _ - - _ • . , - - ' tA1CiE O~Iii1TY P~ ~ ~ : ~ AOBER r011RAS E _ CtEAIt C1RCtqT C01itt _ . acc~R~ VE~~flEO r; A~ 1~1 12 Oe P~!'1~ - ~ 3'76~5 - , - ~I I FUR'THER.CEBTIFY that I~n11 register at m~ local addnss whan tbe registration booics reopea. and ~omplp ~r~t6 all ~ otliet requiremeats ~ s legal resideat of this State. • - i ~ ~ ~ t FURTHE~ CERTIFY that I have no inteatIou to retnrn to m former domiu'le. aad I iatead t~ reau~in ia ' • _ ~T. ~.UCIE _ . ~r. - lCitT) - _ - - . - ; . - Flo~ids, permanonc~,•~~~"- . . . - _ ?i` . . •'g ~ . 1 - i:~ ~ r' . ~ '•~e.t~ . t ~ ~ ~ ~ - ti~ • . t::.~~s ' _ ~ . . ' ~ i=~ G ; C'~ ~ w.. , : : ~ . - ~`~~'a • ~ ~~.Y + ~l ~ ~ ~ ~ ~ ~ 1 • ~ ~ .t"dh' .:,s r ' ' .'t~ __•~,~a,: -,;r ~ ti ; - . - • :0 f~ if ~i.~~ . ~ . • - ~ -'s • ~ j` ` ~i.[ ~Q i . ~ { ~•i ~ . . ' ~ . : . ~.s,~~•~;...~ r 1 . ~ ~ r~'~~ ~ ~ ~ - ~ - - ~/os?/. s" ~ fa-z~ f~~~~~ . _ ~ • . u?aa~,..~ - _ ~ Sworn to sed subx~ibed bciore me tbts 1.~_ day ot ~ ~ ~3 y.S~ ~ ~ ~ ' 1 ^ . A.D.19~., ~~~R POtTRAS. CLERK_ 4F',ClRCUIT COI~tT ~ ST. .LUG 1 E COUNTY, FI.OR t t~1. ' - ~ BY: - - ~ EPUYY LERK . ' . . . ~ . ~ dO~I P~4Cf ~1 AGl~ Perm 7t-22 _