HomeMy WebLinkAbout0005 D~c~arat~on ~T uv~~~~~~~c a~~~ y.~.~~..~...r
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TO TNE CI.ERK OF THE CIRCUIT COUR f. • , • ~
ST L UC 1 E . COUNrY. FL.ORIDA:
• 1Tis ia mr dcclaration o[ Domicile and Citise~ship i~ tAe State ot Ftorida tbat I am Wing thls da7 ia aceordaace. and in
eo~~ormitY with Section 222.17. Florida Statutes. -
~%U/~ S ?~9 //r s/~' G E~.S E-~ and I
I~r~s tormcrl s Icgal resident d~ ~~~r~ ~ uu1
5~ S T'~~~:5 /~~j . Hawever. I A~ve chaaged my domieik ta ~
cesidcd at
(gtre~t ~sd Numberl f.
k ~ day of
and am and have been a bona Cde reatdeet ot thc State ot Florida aince ,~(.^~dCk~
_ 19~_. and I reside at .~-~ir ~ ~ h'C S~'~/T f~'` ~ c-
(Sttrst aad NuanEsr)
ST. LtJG I E County. Fiocida,
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eae,~
and this statement i~ to be taken as my deelaration oi cit'uenship. ectuat legal residence aad domicile in the State oI Florida.
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IF FOR ?'NE PURPOSE Of ENROLIING IF FOR HONESTEAD PURPOSES~
CHIIDREN iN SCHOOL~ PI.EASE S'fATE PLEASE CHECK:
THEIR NANESt
F~[ED E C
sTROCca, P ~NTr~l4
f p~ ~~TRA$
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JUL l
JO .~1 qy ~~P
. . 4~91 ~2 ,
1 FURTIiER CERTIFY that I will register at my local address when the registration books reopen, and comply with ell
; other requirements ot a legal resident ot this State. -
E I FURTIIE:2 CF:E~TIFY thzt I have no intention to return to my formcr domicile. and I intend to re ~ n~tin
! _ , Sr. Luc~E y•
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~ Fiorida, permantn~i~ .
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