HomeMy WebLinkAbout1369 Ueclara~ion of Domicile and C:i?izenship ~ ~
X00 THE t~.ERK OF THE Cl1iCt)IT OOUAT. ~~~a~
S'~.. LUG I E OOVNTY. FLORIDA:
~ 4'6is is mF declaration o[ Domie~e and Q[tiseasbip is the State at >c7orida that I am flliaS this da,T is saoordaaos. and b
. _ eoofarmit~ with Section 222.1T. Florida Statutes. .
I was torme~rj a kssl rasideat o[ ~ v ~ - _ - ~ ~ 4 S and I
-~f~=-~-~ Q ~ I IGb) Istdsi
resided at R T ~ - However. I haw eh:nged ~ domide to
l8t~t and Namarl
:ad am snd ire been a boas bde rssideat of the State of Florida since ~
l.~ ` l 9 7 ~'f daT d
19_~ and i reside at F C OiL' ~
~ I~..t aadN.ab.rl
l.~Ri ,2 C~ ~ _ ST. LUG I E ~ Connti Flo~;d,,
1~
and this statement is to be taken as m7 declaration of dtiunahip. acted ]egal resideaae and domia'le in the State d Florida.
If FOR THE PURPOSE OF ENROt.LING IF FOR HOMESTEAD PURPOSES,
CHIIOREN IN SCHOOL, PLEASE STATE PLEASE CHECKL
THEIR NAMESS
-
i9I9 .AU& ~I'3 ~PN ~i~ 03
- ~u~o,r~o~:co~o
• 3TCltWpffiGOtINT~f FLA.
~fi'FRA$
COUR~
RECQRD kfRIF1E0
~ -
i
I FUR1~R CFRTff¦Y that I w91 regis4er at mT lots] sddress when the registration books reopen. and oooaplT with all
t other requirements of a kgd resident of this State.
~ I Ft11tTHEK CQt1•!FY the I have ao intention to return to wT foraur domia7e, and I intend to remain is
J T. L U C I E _ CountT.
Florida. permaaend;.
- - ,,t,~?o~,~
.a° ~ • ? ,
V~~ iC~ .
s
[t 1 i ~ _
7~t, ~;~C ~ lNa~e)
~1N(1 tAea,..a .
Sworn to and sn belore me this ~ ~ daT of 4~'/~1~~ ni ~ ~
- - -
A.D.19
~ ~ ,
R ~ AS GLERK~ OF CIRCUIT COURT
~ - -
ST. IE COUNTY, FLORtOA - -
•
BY: ~ -
• EPUTY LERK
•B~3i4 ~~i3~~~•
. ~ _