HomeMy WebLinkAbout0470 [~~ct~r~~ion o~ Domic~l~ an~ c:~t~~ensn~p ~
. . ~ ~ ~ ~
~
~ ~ 3~~4Q6 ~ ~
. . ~
TO THE CLERK OF THE C1RCUlT COU1iT. 4~
,
ST. L UE 1 E ~p~. ~,pRIDA:
. _ '
• Tbb b my decl~ratioe oI Domlcile and Citirsn~hlp in t3ie Stata ot Fbrida th~t I am Wlna this da~? in aaocd~nes. and tn
eontamiey witb Section 222.17. Ftorida Statules. ~ ~
.
I was forme~ a bgal resident ot ~ and I .
ICM,~?) l&atd j
teslded at y A . Hoaener. I luve ebaaged my domie~e lo
~ IStn~t ~nd Nrmb~el •
artd am sad bave been a bona Gd~ reudent o! the State ot Fbrida since V`'~ ~~,_.T.~ dy ot
~ . ~ ~.'t1,O ' SOV'~t, v S ~
19 aad I reside at _
~
R'~ ~i~~~. , ST. lUG 1 Esu~:.c..dN~~ ,
Couatr. Florida.
(CW! '
" and thts atatemeat Is b be taken ~s mr deeLration of eitizeaahip. actu~t legat residenee and domic~e Iu tbe Stato of Florida.
Ii iOR THE PURPOSE Oi ENROLlIN6 Ii FOR HONESTE/1D PURPOSES~
CHI~OREN IN SCNOOL~ PLEAS~ STATE PLEASE CHECKS
THEI NAMES2_ ~ ~
,
. ,
. . - . i
_ ,
1 • '
i:
~U
~E
~
ROCER AOITRAS ~
ClERK C:ACUtT COURT
: yrntFlEO
• F
~ ~ ~ Auc 15 9 3s AN'7~ c
;
~ ~
. - 3~s4os ~
I FURTHER CERTJFY that I will register at my locd addres~ when the registration books rcapen. aad compty with aU
other cequinments oI a lega! resident of this State.
I FURTHEZ CEBTIF'Y that I have oo irttent~on to return Lo my former domicile. and I intend to rcmain ia
- ' $T . L U C I E , County.
tCit~) . .
Florida. permsnenti~ . -
~ ~ i
~ i
~
' - . , j
:•iT ,.y';''G~ ~i
• . ~ r , - •
. ~
- y" • 'I?,~# r~'ti„~? .
' J~ i.'.'; -:3~~s°j~~~i ' ~ ~I
. ? .
. `Y, ~ .
~"L, rc- • .
~
~ ~ 1 V ~ ~
Svrorn to and substribed be(ore me thu d~?y of •`~,.,~i.iJl~
. A.D. l9 7~~ - ?.~P ~ ~SQ ~
ROGER POi TRAS. CLERK OF C IRCUI T C4UFtT
ST. Lt1C t E COUNTY, F I.OR 1 UA ~ ~
' ~,r: ~ _ - ' , ~
EPt1TY RK
• . . .
' 0 R'q
' BOOK ~G~ PACE 467 . ~~o ~
o, ~ .
~
~ _ ~ : . - - - - .