HomeMy WebLinkAbout0936 t~
Declaration of Domicile and Citizenship
~ ~
45~48o f
700THE CLERK OF THE CIItCUIT COURT.
ST~. LUC 1 E OOUNTY. FLORIDA: ~
~ 4Lis if ttgT declaration of Domicile and Citisenship io the State of Florida that I am this daT in aooordanoe. and is
. eoalormitT with Seetiou 222.17. Florida Statutes.
V
I wa: former a kcal resident at ~ ~if~y~-S and I
IIxV) 18tat~l
resided d However. I have .clanged tm~ domier7e b
1 and / Lc.
and am and have been a bona Sde resident os the State opt Florida dq d
O L Tp~r/ ~
lJ 19~. and I reside at
It~.ad liswb.rl
~ ST. LUG I E Ceti.
ICtt71
and this statement is to be taken as mT declaration ~ dtizenship, actual legal residence and domieDe is the State of Florida.
Ii iOR THE PURPOSE Oi ENROLLING Ii iOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECKS
THEIR NAMESS
. 1919 1?UG -9 PN 3 t12
~p ~pp~
ST~~IE COUN{~•~~A.
~tOGER P01 A
~ERit CIRCUR LOUR
RECORD VER1ftE0
45448
I F1TR1'HER CERTII''Y that 1 wr11 register at mT 1oca1 address when the registration boob reopen. and complT with aD
other requirements of a legal resident of this State.
I FURTHER .CERTIFY that I have no intention to retnra to mT former domiu'le, and I intend to remain in
U t E Connt~.
j _ IGd~) ~
Fbrida. permanentl;
. i
4
}i
44
f
3
2
• t
,L Jp~/
is
//-s`n .
~ ~ /f~~ IAddr.~
Sworn to and snbsm~ before me this _ !YJ- daT ~ ~ G E_ / I~ ,
- - -
A.D.19
~ ~ .
i
>
R A C ERK OF CIRCUIT COURT "t~°
~ ~ _
,,~~sy~,. .
ST. LUC 1 COUNTY, f LOR 1 OA - ~ ` 'O,r~,,,.: ~ r
• , tour 1.. `:4 r
600 ~ PICE t7~.KJ ":'!41i ~ ~T . ~ ~
. -
.7