HomeMy WebLinkAbout0574 _
' ~ omicile and Citizenship
Declaration of D
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4,zS~.95
• TO THE CZ.ERIC OF THE CQtG'UIT COURT. ~ ~ , . + t ~ - - • .
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S?. Lut 1 E ~ covrlT~r. FLOItIDI~
• ¦ This b a~? declaration o[ Danicils and Citisensbip in tM Staa of Florida that I am tilios tbb dq is aeeordaoos. and is
eoato~mifJ? with Section 22Z.iT. Florida Statutes. .
• MIC.1.1 L~~-Wh~ aadl
I was to~~ a ksal resident of 1 latattl
raided at 1 1 ~ k ' Ors AoMrevsr. I Uaw ebae~sd W? doaaiede to • .
tBteMt ~ NwnO~r
~a ~ U trlU T~~t~~.1~._dar ~ -
aad amand bays been a boea fide seaideat of tbeState of Fioridasines
1.19 aad I reside at ~ g d S ` ~v ~ //y ~ ~
_ 1Strwt aid Nro~l
~o R ~ tS T ~ ~ _ ST. luc 1 E ceunty.>r'loridi.
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u+d this statement is to be taken as trgr deekntioa of citizen'sbip. aetusl kcal residence and domicile is the State of Florida.
IF FOR tHE PURPOSE OF ENROLLING IP fOR HONESTEA~ PURPOSES
CH1t.OREN IN SCHOOL, PLEASE STATE ?IEASE CHECK:
• THEIR NAMESS
V ~V ~ ~7 ~'y ~ 1'`tOM~cSON ,~`'~EQ ~:R~ ~ ~~ECOr~DED
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4~a.9s
- 'i3 Z ! kf~l IL : 32
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I FURTIiER CERTIFY that I wal register at my local address when the ngistratioo books reopen. and comply wiib all
other requireuneats of a legal resident o[ this State.
I FVATIiER CERTIFY that I have no iateation to return to m1rT
or
ieuc ;~'ie• aAd I i'°tend tO ~~nty.
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Florida. permanenci~ .
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Sworn to and subscribed before me this ~
~ day ot. ~ R ~ S ~ ~'-Gy~j=-~,l~s'~"-`-'
~c • ~~.p.~9.78 3~~~ao~'
ROGER POi TRAS CLERK 4F CIRCUIT COURT
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ST. Lt1G 1 E COUNTY, f LOR 1 A
EPUTY LERK ~ P,?f ~4
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