HomeMy WebLinkAbout0266 Decl~ration afi Domicil~ anq Lit~z~nsn~p ~r
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Z`0 THE Ci.ERK OF THE CIRCUIT COURT. '
ST. Ll1C 1 E ~pUtv'ry. FI,pRIDA: ~
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TGb b eny dcclantion ot Domicile and Citiunahip in the State ot Flotida tlu~t I ua tsflna thb day in teeordance, and in
tontocenity witb Sectioe 2~.17. Fioeid~ Statutes,
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I ~ra~ to~ a legal te~ideat ot and I
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1 ~ . - How~ws. I hava ehanged anr domicile to
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aad am and ~w beea a Doaa tde re~ideAt ot the State o~ Flocida siacs n? ~,J ~ 3~' dq ot
19~~.. ~d I ceside at l ~Z -
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" and this statemeat is to De takea u my declantioa oI eitiunaAip, attual kgd reaide~ee and docnieile ia the Stato ot Fbrida.
If FOR THE PURPOSE OP ENROILING IF iOR HOMESTEAD PURPOSES~
CHILOREN IN SCHOO~~ P~EASE STA?E P~EASE CHECK: ~
?HEIR NAMESL
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39'7945
I FURTNER CERTIr'Y that I wilt register at my local addres~ when the tegi~tration booiu reopen. aad comply with all
other requirement~ ot a legal resident of this State.
I FURTHE:t CER FY thst I ve no intention to return to my iormer domicile, and 1 intend to remain in
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Fbrida. permanenti; .
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Sxore to an Jaubscribed bc[oro mc this ~ day oI -
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. A.D.19~ ~.~t,l~l:~-~ ~ -x, G/1~.~~. .
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ROGER P01 TRAS, CI.ERK OF C tRCUi T COUF2T
ST. lUG 1 E COUNTY, f lOR t UA • -
~Y 600K~~ PACE ~11U
EPUTY LERK
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