HomeMy WebLinkAbout0826 of Domicile and Citizenship ~
D~claration
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~ TO THE C1.ERK OF THB CIRCUIT COURT. .
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~ ST. LUG I E COUM~t. F~ARIDA: .
• Tbis b aa,p dataratba oi Doa~idM ~ad Citi~en~Rip in tba Stat~ d Florida that I ua tiliaa thb dU? ia aeooe~dana. aad ia
ooota~mitr with Seetion 222.17. ~7orida 3tatutei.
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I Mras to~ a kksaal ~sident aI 1CUr~ 18ua1
eeaided ~t ~ d X +~`l`' ~ - Howevee. I I~ave ehanaed m7 do~nieik .
18t~«t ~d N+~Mri ~ P ~ dv ot
~ n d a m u?
d h s
v e b e e
a a boaa C~de resident ot tbe State ot Fbrida sinee f
.~l.sd~l.e - i~~ ~ai,~a. ~t ~ o ~ s " ~ wc~ .
~ea..e,~.a N~?
„~b C. (--v~ e. _ ST . L UG I E Councy. Flocida.
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and this sLatet~nt b to be taken as e~ deetaration o[ eitiun'shlp. actual kgal resideiue aad domia7e ia the St~te o[ F7aida.
if POR THE PURPOSE Of ENROLLING IF' FOR HOMESTEAQ PURPOSESi
CHIIOREN IN SCH00l.~ P~EASE STATE PLEASE CHECKS ~
THEIR NAMES: ~
GZ M,~ Pd t~ ~.~.1 S - a. Mc
fILED ~M~ RECOAOED ~
- ST. IUC~E C6UNTtt FlA
ROCER POITRAS .
CIERK CIZCUIT COURT
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JuN 11 .12 s2 PM'18
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~ I FURTHER CERTIFY that I w~71 register at my iocal address ~vhen the regis~ntion books reopea. and eomply with all
~ other requirements oi a leBa1 *e~dent oi tbis State.
~ I Fi1~tTHg,R CE~~r thst I hsve 1W IALCAt10A to return to m former -domicile. and I intead to remaia in
! ~6 c-t~ C-t- l_•-t ~ r e ~T . L u c i E . c~ncr.
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Floriaa. permanencl; . ` -
~
:~Ot1hTy LAN~Y`~ .
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V ~ ~ f' }Name) .
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~ Sworn to and subscribed be[ore me this °2 ~ day ot
~ . A.D.19. ~ 8
~ •
ROGER P01 TRAS CLERK OF' C IRCUI T COURT
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ST . L UC I E GOUNTY, f I.OR 1 UA
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EPUTY LERK U~~,,,,~Q ~ a~~
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AGO Furm 71
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