HomeMy WebLinkAbout0564 ' of Domicile and Citizenship ~
Declaration ~
428186
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• ST. lUC 1 E OOUM'Y. >r'I,ORIDA:
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Thb b ay? dedaratioa of Domkik and Citiseaship to tM State of Florida that I am film= tbb ds~ io aeeordaoa. and is
eoAfarmitp wits Section 22Z.iT. Fbrida Statutes. - •
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1 was ~riX a kEal raWsat of TPLNTON
1~y Sti~konA Is~•w
• TY e n t o n ~el~~•C. ~s~°t-t°`~~ SW ~i'~o~'+ t'`~ ~ _ j~rer~ 1 bare ebaa6ed aq? dond~e to '
rrsided at Ne~tl .
~}Wer~1~c_el t.~ day of
and ua and have been a bona fide residsat of the State o[ Florida sines
~e~ e..~rLbe.•+r - iil~.... and I reside st a$I'f . ' S.E. T'~.~Y .~K~-~" -
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PaC~ ~ ~ „ ~ = ST . LUG 1 E County. k'lorida.
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and this statement is to be taken u my deelsratioa of citizenship, actual kgal residence sad domials is the State o[ Fbrida.
If- FOR THE PURPOSE OF ENROt.LING if FOR HOHESTEI?D PURPOSES
CHILDREN IN SCHOOIs PLEASE STATE ?LEASE CHECKS
' THEIR N1IMESS
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= 481.86
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FUftTAEB CERTIFY that 1 wRl register at my local address when the registration books reopen. and oomPlY with aU
other requirements of a legal resident of this Stats.
I FURTHER CE that I ve no intention to return to my former domicile. and I intend to remain in
• ~ ~ o , _ - ST . 1.. U C 1 E County.
Florida. permaaand~ . '
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INanM)
(AddeNal
Sworn to and subscribed before me this day of
ROGER p01 TRAS CLERK Of C 1RCU1 T COt~2T
ST. LUG i COUNTY, f >_OR t UA -
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AGry F'crm ~1 :