HomeMy WebLinkAbout0295 u~c~arat~on oT uomic~~e ana ~..~~~~G~~~~~~N
• ~ ' 414949 .
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TO TIiE CLFRK OF THE CIRCUI'1' COURT. • . ' . ~ :
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This b mr decla~~tbn ot Domicite and Cit~caship in thc State o~Florfda ttu~t I~m filing tAis day ta aeeordanca. and M
eontornuty with Sectwn 2~.'.1T. Florida St~tutes. ~ ~
I rrss tarmrr! s lcga! resid~nt o( S'~~ ~ A~ Cp~ ae?d I
ICit~j iStai~
~~i~~ 3~~ ~ However. I htve eMaged mr domieile to -
19ter~t ~ud Nuo~l
and ~m and have been a boRS Gds re~ident oI tAe State ot Florida siace day ot ~
~ 19.~C.~ and I nside at . ~ %
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/St~wt aod Nwa~r)
T u ~ S?. LUG ! E Co„pcr. FMrida.
~aer~
aad this st~tement is to be takea a my declaration oi eitizen'ship. aetuat lega! nsidence and domidle iA ibe StaLe o[ Florida.
IF FOR 711E PURPOSE OF ENROLLING IF FOR HOMESYEAO PURPOSES~
CHILOREN IN SCHOOL~ PIEASE STATE PLEAS'E CHECK: ~
' THEI NANES.
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s~.luc~E c~u~Tr Fi~.
_ ROCER Pp1.TRAS
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.~._R:F~ED
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~ ~~14949 ' ~
I FIIRTIIEEi CERTIFY that I w~71 registcr at my loeal addres~ when the registration books reopen, and complr ~~th au
other requirements ot a legal resident o[ this State. ~
I FtJRTlIE3 CF.KTIFY thst I have no intention to return to my former .domicilc. and I intend to remain in
' /^.ZT Si l tr c ~ c ~ S T. L U C 1 E , County.
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Florida. permancntl; .
; ys CIR~+
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' G/Z ~LGC~-i AV c' :
(Addrew)
Swo: n to and subscribrd before me lhis - Z~ day of RT S~ G lt C/~
_~L1S ~ _ . A:I).19.7 ~ .
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ROGER POITR~S, CLERK OF CIRCUIT COU2T =
ST. LUC 1 E COUNTY, f LOft 1 UA •
BY: ~
EPUTY ICRK ~ ~
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AGO !
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