HomeMy WebLinkAbout0672 D~claration af Domicile and Litizensn~p
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• TO TNE CLERK OF TNE CIRCUI'C COURT. • ~ , ~ =
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' ST. LtJG i E COUNTY. FIAR2vw: -
Thia b my dect~ratioo ot Domlcile and CiL~enaAip in the Siate oI f'lorida tA~t t am tdln~ thls da~ iA secotdaaee. snd in
eonformity ~rith Sect+oa 222.17. Fbrida Ststutes.. J ~
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I ~?ss ~orm~~l i kgsl n~ident ot
tcay~
sesided st . How~ver. I hava rhsnged my ieile W•
19t++~t wd Numbetl
and aan sad have n a boaa C~de resident ot N+e State oi Florida aince ~ d+7 ~
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L~. 19 and I reside tt ~
- sed Nu 1 ;
~ ~ ST . l Councy. Florid..
l(~is71
and this atatement i~ to be taken ~s my decluation ot citiun'ship. ~etual legal nsidenee ~ad domicite ie the State ot Florida.
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IF iOR THE PURPOSE Of ENROILiNG IF FOR HOHESTEAO PURPOSES~
GHiI.OREN IN SCNOOL~ P~EAS.E STATE PLEASE CHECK: ~
• THEIR NANES: /
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a~
iuc
F couMTY ~i,°~.
~ ROCER'01TRAS
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I FURTIiER CERTTFY that I wil! register at my loca?1 ~ddress when the registration booics reopen, sad comply with all
other requircments ai a Mgal resident ot this State.
I FURTIj~ CF.RTI hat 1 1?ave no intention to return to my formec domicile, and I inlend to remain in
0 ~ T ~p Y C~ _ , ~ T~ U C { E - - - Couniy, -
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Florida, permanen~i; . ;
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COUNTy -
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Sw orn to snd subscribrd be(or~ me this dey ot T i~-r C?~ _ ~~0~'/ Q Q~
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ROC.ER P01 RAS. CLERK OF C IRGIiI T COURT
ST. LUG 1 E COUNTY, FI.Ok 1. •
BY:
. EPUTY LERK ~~K~ ~
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AGO Form Tl ~4
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