HomeMy WebLinkAbout2471 Declaration of Domicile and Citizenship
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TO THE CLERK OF THE CIRCUIT COURT.
ST. lUG I E COUNTY, FLORIDA: -
This b n~ declaration of DandeGe and Citlaenship in the State at Florids that I am Sling thb dy is aeoordana, and is - .
wnlormfty~wtth 8eetioa 222.17. ~7orida Statutes.
I wu fo~ a teaal resident at a wi
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resided at j_~ M`°C/~/~/~~. Iav1 _ However. I hav changed mg? donaieije to
l8t~w~t aad Nawbsrl
and am and have been a bona Bde resident of the State of Florida since
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Ft [iltRR/ ,19 74.4- and I roside at RT 'f~ Boni 3P4~ -
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. i'T. Picitc ~ - ST. LUG 1 E Count. Fforids.
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and this statement b to be taken u ~ declaration of dtisenship, actual legal residence and domidk in the State et F1osida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSESi
CHILDREN IN SCHOOLa PLEASE STATE PLEASE CHECK2
THEIR NAMESi - I
~~C~'s1.+ /9yw S.4.e6,E.?>- ANO RECORDEb~ -
F11.ED ~E COUNTY. ~l.A•'~ '
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'i9 FEg 23 AN 10 •
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I FURTHER CERTIFY that I wiU register at m~ local address when the registration books reopen, and comply with sU !
other requirements of a legal resided of this State. ~ .
I FURTHER CERTIFY that I bave no intcntion to return to mT former domie7e. and I intead to remain in
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j Florida. permaaentl,,.. .
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• ' zti ` ~ ~A`` w _ (Name)
sworn•to and su
;~bserfbed before me this ~ ~ asy a[ ^ .~~SO
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R~ER P01,jRAS„ CLERK Of CIRCUIT COURT
ST. LUG I E COUNTY, FL.OR t A .
BYs - -
~ _ E PUTY t.ERK
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AGO Form 71 ~
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