HomeMy WebLinkAbout0638 D~ctaratiQn ar ~am~c~te ana ~~a~«~ ~~...N ~ ,
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TO Z'f tE CLERK OF THB CIRCUIT COURT. . ~ , ' ;
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' ST. Ll1C I E CpU~y, ~,pRIDA: ~
This ta mr declarati~ti oi Domicilo aad Cit~easbip In the State oI Florida thd I am filin~ tt?i~ da~ ta ~?teordaace, and in
eoatorrtity with Scction 22'~~.17. F'lorida Statu ~
~ G ~y C~~i~~L67~i.~ and 1
I+vas iormerir a kgal resident ot - ~ c .
nsided at ~a ~ ry~~Q ~~r' . However. I tu~ve ehangrd my domicile to •
18wat.sd N~mMr)
aad am snd l~ave Deen ~ bona C~de re~ideat ot the State o! Florid~ sinee ~ dar ot
~ L~-~ .19 7 8- and I teside at 1/ ~UAN 7'~ / r~/Z L G
p tsuwt,,,~a N~e.t?
a~.~' L~' .i[ /4 v C,~- ST . L U
G i E County. Fbrida.
(c~y!
and this statemeat is to bc takea as ~?r declentioa of eitizen~hip. actu~l tegal eesideace and domdcile iu the Stste of Florida.
~I~ iOR THE PURPOSE OF ENROLLING ~F FOR HOMESTE/l0 PURPOSES~
CHIIOREN iN SCNOOl~ PLEASE STATE P~EASE CNECK: ~
' ' THEIR NAHES:
' j ~ E,,,~ ~ ~ .,.._,LYi FE ~~~v ~ vc.V
~7'-E~~e ! FC- ~1cn•'fiwv~.cf
DO~vAC ~ E R. FE /Y1 GK~ i~'f v~+nl '
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I FURTIIER CERTIFY that I wt~l register at my tocal address when the registration bootcs reopen, aad comply wit6 all
othcr requircments of a kgal residenl. of this Statc. '
I FURTEIEZ CF:RTIE'Y that I liave no intcntion to return to my Iormcr domicile, and J iatend to remnin in
,.$~f ~ u ~ ST . L U C 1 E . CouMy,
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Fbrida. pernwnenti~.
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CtiERK CER,CrW CO
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Sr?orn to and subscrib~d betore me this a" ~ day ot .
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, A.D. ]9. 7 8 ~1~•~4~~
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ROGER PO! S. CIERK OF C iRCUI T COI~t~; ~
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ST. ll1GlE GOUNTY, FL 1UA ~ : = ='~4 . ~
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