HomeMy WebLinkAbout1662 _ :,x
t~ecfaraYion of i~omicile and Li~izenship
45951
'l0~ THE t~RK OF TIC CIItCUIT' COURT. {
S~~. t. UG 1 E COUNTY. FLORIDA: ~
t
' ~ `;This is m, daeiaratiao of Domicile sad (~tizea~ship is the State d Florida that I am Elias this dq is aooordanoe. sad is
_ conforesits with SediQa x'22.17. Florida Statutes.
I wa: forrnerl s legal resident o[ ~ ~~.5,! ~ - and I
Itat71
rnided at ~ 75 W: /kes ~ / el ~ ~ However. I bare changed np domie~e to
l&++~? aid Nassb~rl
and am and bare been a boas bde resident d the State d Florida since ~ w ~ / ~h dsT d
b r`[./ r lg~ and I reside u ~~~d .~11 . S /Q',I~o Al/ ~ ~
~ ST. LUC I Es~a..c.aa>v.o<e•rf '
. coenti?, Florian, f
1~
and this statement k to be tsken as ml detlantioa d citizenship. actual legal residence and domicile is the State d Florida.
D
If FOR THE PURPOSE OF ENROLLING IF FOR HONESTEA~ PURPOSES
CHILDREN IN SCNOOIs-PLEASE STATE PLEASE CHECKS
T-HEIR NAMESS
2
t - • T
454951
_ ~T9 AUG 14 PN I~ OS
Ft~to ~u+~ r~coRO~o
ST``UCIEE tIUMTY.F A.
~tOGER POITRA~
CLERK CFtCUIT OURT
~ RECdRp VERIFtEs
I FURTHER CEATlF'Y that I w~71 register at m7 Local address when the registration books reopen. and oomplT with all
other requirements d a kgal resident d this State.
I F'ITRTAER CER1'1FR that I have ao intention to return to mT former
d~_ule. sad I intend to remain in
5T ~ L v c ~ E _ Count. t
a
~M•~l
Florida. permaaend,.
L' (AdBe.wl
Sworn to and snbsa~bed betoi+e me this 17,~ d aT of .14~~~,_„~C/ ~~'1
_ .
. - _
A.D.19. ~ ; `
~ ~ - -
R A CLERK OF G I RCU 1 T COURT
ST. t_UG I E COUNTY fLOR t OA - - . ,l J~`'•'~pilti~:. -i
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soj~x 314 PaGE~.~~ . - 5,,, . l
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