HomeMy WebLinkAbout0874 ' pecl~~ation of Domicile and~~ Cit~z~nship ~
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TOTHE CLEItK OFTHE C1RCUlT OOt)RT. ~..3'7~669~. . ~ ~ ~ - ~ 1 ~
ST. Li1C t E ' ' , ~ ' '
~ ~ ~OUN'1'Y. FLOAIDAs . :
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'lUis b my deetacation o[ Doa~kile and Citiseeshlp in the Stats oI Fiorids iha! I un tiW?a this dqr te kcocdtace, s~d ln #
toeJotmity wilh Sectioit 222.17, Flotid~ Statutei. !
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I wras formerlY s kgs! reatde~
t ot ~~~J___.__. , u~d I '
, ( lCltil ' 18tatd ~
~w~a,?t G!~ ~•Gf/t - Howsv~s.1 hane eba~gcd e~? domkile to
tserac wa Nemar) • ~ `
and un aad have beeb a bona C~de te~ideat oE the State oi Florida ainee S~ -~7 ~ day oi ~
re. T_ _.T_ _
!8_`_.. and i reside a! . / ~ ~
. _ lSt»~t ~ad Nrmb~ti ~ .
, - ST. IIJC 1 E Councy. Ftorid., ,
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' aad thi~ atatament is to be taken as my dec4ration ot eitiu~sldp. actual tegd re~ideace ~nd domic~e in tfie Stato ot Fbride.
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IP FOR THE PURPOSE OP ENROtLING ~ IP fOR NOMESTEAC PURPOSES~
CHiIOREN IN SCHOOLi P~EASE STAtE P~EASE CHECK: ~ ~
EIR NANESS ' ~
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' Cl.ER C R~lT~ YRt
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i FiTItTHER CERTIFY Ehat I w~71 register at my local addres~ ~rhen the rcgistration booka reopen. and comply with all #
ather req~eirementa ot a legal resident of this State. ~ . ~
I FURTHE~ CERTIF'Y that I have ao intention to return to m former doinici'le. ~nd I tntend to remain in
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Flocids, petmar.enti;.
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Sworn to and subscribed be[ore me thi+ .~oLd¢= day ot ~
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_ A.D.I9 7T _
RQGER POlTRASj CLERK OF CIRCUIT COlX2T
ST. LUG l E COUNTY, FI.OR tUA ~ .
. BY: - _ .
~PUtY ~c~n
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ACO Fora~ 9t~2Z
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