HomeMy WebLinkAbout1418 • r^
Ueclara~ion o~ Uornicile anti C;iizenship
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LUG i E COUNTY. FLORIDA: -
l7ds is m,T daelaration d Domicile and G~tisenship in the State d 1c7o:ida flat I am this daT is aoooedaooe. and b
eonformit,T witD Seetioo 228.17. FjaridA Statutes. ~ L
I wa: i~.letal rssideat o[ 1 I _ c+ CU'1 ~ aad I
(c+~?1 (s+~sw
re:iaea at C ~C~re IY1t~ n-t" `~ft~°`{' - However. I h:ve ebang.d m, dom;~. t.
- (StrMt aad Nnmb~ ~ .
and am and line been a bona Ede resident d the State dFlorida since ~1 ~1 ~b ~ _ dad of
19
~1
~ - and I reside at ~ ~ r ~
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t~S~r A'U ~C_1_ ( 1 P ,
(sa..t aaa Narb~
F-f- • ~1P~CC~ _ ST. lUG I E Count~.Flarida. -
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and this statement is to be taken as m~ declaration d dtisenahip. actual kgal residence and domia'le in the State d Florida.
IF FOR THE PURPOSE OP ENROLLING IF FOR HOMESTEAD PURPOSES,
. CHILDREN IN SsHOOL, PLEASE STATE PLEASE CHECK:
THEIR MANES:
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X19 AUG 13 PN Z~ 21
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A.
- 1~0a POITRA~
CLERK CiRCU1T COURT
RECORD YERIftEO
I FURTIIER CERTIFY that I wDl register at m~ local address when the registration boobs reopen, and oomplT with all
I other regniremenb d a legal resided d this State.
I F[JRTAEIt CERT'I1'Y that I have no intention to ntnrn to m~ former domicile. and I intend to remain in
` u c E Count.
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Florida. permanend~
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Sworn to :o before me this dad of
R ER A C ERK OF CIRCUIT COURT
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ST. LUG I E COUNTY, f LOR 1 OA
• E P UT Y E R K a~~K 3~~ Q1Yb'~~~~ _
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