HomeMy WebLinkAbout0590 tion of Dorriicile and Citizenship
Declara .
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• SY Ll1G 1 E C~ovN1'Y. FiARIDA: . '
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• d Domjetl~ ±ud Citi~snship ia tM StaU oI Fbeids tb~t I sm lWa~ this da,~? in aoooe~d~nee. and in `
l~i is u~? daLratioa , .
~ with gect;o~ 4Zt.17. Fb~ida . ~
I was ~ ~~~°t QI ~ ~ / 18tsa) i.
Ao~wwee. I Iwve ebanaed aU? ~ tO `
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tew.~..a N..e.~) ~ ~ Q~`~ ~ O da,~, ot `
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and m and b~re beea a boaa fide e~esideat o[ tbe State ~ Florida sinee ~ ~'~R.SC`~~
~ i~ ~ aad I reside st °
l8tri~t rd N~bKI
r, (2.,'~ ~~v ST . L.UG 1 E Conntr. I~'larida.
~ ~ 1C~41 m the 3ta~e ot Florids.
aad t?ii dat~ea~ent is to se 4k~ as m~ deefsratioa oi dti~snshiP~ actud iegal resid~ace and do~niei'1e ~ .
Ii i0R HOMESTEAO PURPOS 5~
If fOR TNE PURPOSE Oi ENROIlING PLEASE CHECKS
Lp~~pREN IN SCHOOL~ PIEASE STATE
THEIR NAMESi
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- fILEO ~MD RECORUEG
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Cl ERR CiRCU1T CdUP.
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4U'761;~ 21 I s9 PN'T~ ;
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l ~ CEA'I"IF'Y t6st I~1 ngister ~t my local address whea the reg~tntion booi~s reopen. aad comPb •vir.h a11 ;
I i
otLer re9~r~c~s oi s iegsi *esident ot this State. ;
. I w~,n~~sfy tiut I 6ave no iatcntion to nturn a m~ form~r do~nieile. aad I intead to re~nty~ {
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Sw and subsm'bed betore me thu '
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A.D.19. 7 8 • i~
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- OGER P01 TRAS, CLERK OF C IRCUI T COU2T ;
ST. lUG i E COUNTY, f L.OR 1 UA ~ -
BYs .
EPUTY LERK -
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~ . AGO Fnrm 71 2"
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