HomeMy WebLinkAbout0670 d~ctar~ti~r~ ofi C~~r~~c~~e and ~etiz~~-~~hEp
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TO Tl I~ CI,F:ItK OH 7'!IE CIRCUIT COtIRT~ • f
M ST~L t1C I E ~ rnucvz~t. ~LOK[DA:
This is my deeln~ation ot Dumicile and Citizrnship in tAe Stete ot F'lorida thal I am tiGng this day in aecordance. and in
con[ormity with Section ~.17, Florids Ststutea.
I was formeriy a irg~i ~•C.iS~~~i oi l: c•, ~~v-~ ,_•L /v•• y and I
Q . lCitYl - lState~ ~
residc~cf at ~/'Q ~S ~~_Q ° d. ~c~. ,~iowever. I h~ve el~anged mr domecile to
Ber~e~t and Numser)
and am and have been a bona fiide resideni of the State of E'lorida since ~J~ 7~_ day ot
~ .19 . and I reside at 3~~' S• W f_ ~ V t~~. ~ d
(Street u~d Num er)
ST , l. UG ( E County, Ftorida,
ICit~) ~ .
and this statement is to be taken as my declaration of citizenship. actual logal re+Idence and domiciie in the State ot Flocida.
IF FOR THE PURPOSE OF ENROIIING IF FOR HOMESTEAO.PURPOSES~
GHILOREN IN SCHOOL~ PLEASE S7ATE Pi.~R~E ZS;~LK: - j~~
THE 1 R N/~MES: ~
/~Iq ~/Mvn/.~~ -~~/qli NF
C~~7~~L FS ' ~ RECdR0E0`• ~ `
~iLED aND 1
' !_'JCIE C~JU~~TY~.n~'a' ~
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. ~ ~`~~~25 .
1~~'~ +Tg NOV 20 A~ i i• 35
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I}'t(EtTiiER CFRT1Fl' that I wilf rngistPr at my 1<xal addres~ when the registration books reoF?en, ~nd comply with ati
other requin~mcnts of a i~fia! resident of this State. • *
I Ft32t7'fif:;t CE:RTIFY that I haec~ na intrntion to rnturn b m• former domicile, and l intend to remain in
. 7~ U C I E . County.
(City! .
FloriJa, p~rmanenti;. '
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fiv?•n~n to and soh~rrhrd f1e(are rtt~ tt~is __,~D ds~• of ~'~,~T S T_ ~ Gf G'( /c N. ~
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RC1GE=~1 P01 TRAS,_Cl_ERK OF G IRCUI T COl4tT
ST. L.UG I E CCIUN7Y, f LUft 1 uA ~
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