HomeMy WebLinkAbout0973 ~ t
Deciaration of Domicile and Citiz~nship
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T01'HE CLERK OF TtIE CIRCUIT OOURT.
ST. LUG I E COtlNTSr. FiARIDA: ~
This ts my declustioo ot Domieib aad Cltiseaihip ta ths State ot Fbrida ihat I aan Glins tl?V dyr in teeordanee: and in
coatotmity witA Seetio~a 222.17. Flor~da Statutes..
I was formeri • letal resident ot s~~ u~ctJ e~P/.S~v ~ I
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resided at 3 7~• O4K S~L ~ - Ho~?eves. I!u?ve c6aaged aq? domiak to ~
t~tr~t ~od N~mo~e1 - . .
and am and bave bcea a bona ~ide naWentot t6e Stata ot Ffo~ida siaca ~eJ U~ /3 _ . ~y ~
~ -1~~~. and I reside at i~0 ~ N i~ A~2~Y'~ I~Y G t I«. /~P , ~
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~or f S~ , c.uc , ST. LUG i E cCo",nc~,
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and t6is stateraent is to be takea as m~? deciarattoa of citiunship. actual kgal reaidenee aad domicile ta• the 3tate oi Florida.
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IP FOR TNE PURPOSE Oi ENROLLING If iOR HOME.STE/10 PUR~POSE_,S,f ~
CHII~REN IN SCHOOL~ Pl.EASE STATE PLEASE CHECK: x~
THEIR NAMES: • ~
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E COUNT~Ir FIA.
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I FURTHER CERTIFY that i will register at my locml address abea the registratioa books reopen. and a,mply with ull . f.
otber reqnirements ot a kgal resident oi t6Is-State. ~ ~ ~
I FURTHE CERTIFY tlut I have no int~~tion to return to m former domieik. and I intcnd to remain in
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s'~ . ~ ~T . L U C 1 E ~ ._Coanty.
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~ Sworn to and subscribed before me tAis ~ day ot ~a 2T 5 ~ V G t~, r~l ~ 3~'`t
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~ ROGER POi IRAS,~, CI.ERK OF C IRCUI T COU2T
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ST. LUG I~ COUNTY, F I.OR dA •
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~ EPUTY LERK
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