HomeMy WebLinkAbout0988 V~rV~Li~ G~~~V~ ~ V~ VV~~~~V~IQ A~ ~W V~~~~.v~ ~v~
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TO TNE CLERK OF THE CIRCUIT COURT. . ~ -
ST. LuC ! E ._COVt~rr~r. FtAtuD~: ~ ~
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Th~s b my dcclan!!on o[ DomleUa and Cilisoaship in the Stato ot I~`lorida tha! I am Wtng tl~ts dyr ia ~ooo~rd~?nce, and in E
eontorrnity with Sectlon 2?Z.IT, Fbrida Statute~. ~
I wa t~~ a kgal naideat o~ PA~s„~,L~,~ .~P..ld v ~iC and I • ~
. . ~ ICW?) I~ieat~
re~ded at,.~, , . Q,~o rep - Hc~revse. I fuve ebanged my domicile to .
tatn~t wd N~a~~
and ua ~urd bavc be+en ~ bona Cde rosidsat oi the State o! ~7orida siaea ~ d~y o!
19..~.~. and I rostde at ~ ~ ~ ~ ~ . .
~ ~ Cr~- ~ ~ ST. lUG I E •~N~~ .
"r- ` ~ . County. Florida~ ;
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' aad this atatsmcat Is to be laken ss my dee4~ation ot e3tisem~tp. actnal lcgal residcnee and domie~e in the 3tato ot Florida.
If iOR THE PURPOSE 01' £IYROttINC, ' If FOR NOHESTEAO.PIfR~OSES~
CHfIOREN IN SCHOOL~ Pl.EASE STATE PLEASE CNEGK: , ~
THEIR NAMES: ~
_ B,~tia_ C~~? _ s~i~~r~c
E c~u~m? ~i.
_
• ~ CtER~Q~
RCU
t
COURt
t~ [L l- ~ j~~,eYL ~r.~ yfRrF~l~o
' a~c 19 9 i2 AN'~
r..~~ _ ~_r ~
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I FURTHER CERTIFY tlut I w~l register at my Wcsl addreu when the registratioa books reopen, ~nd eompty w?ith ~?11
other requirements o[ a kgal residenl ot thi~ State. . ~
I FURTliE;t CERT~F'Y thst I hsve no jntention to return to my former domicile. end I intend to remaio ia
P~-, S~ .,Luc, e ST, ~ uc . Co~otr.
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Flotida. permanenc~. .
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• N ~ (Nam.)
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Sworn to and aubscribed bcforo me this ~G- dar of N"T ~-UG I~_
' V A.D.19 7~r..
ROGER P01 TRAS, CLERK OF G IRCUt T COI~tT •
ST. LUG i E COUNTY, f I.OR t UA ~
BY: - ~ .
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- EPUTY LERK
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. ' A GO Form 7! •22
. _ . . . P~~ 9$5
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