HomeMy WebLinkAbout1808 x*:
Veclara~ior~ ofi domicile and Lifizenshi
p
~oraE c~» oF~ c~ccn~roovKr, 4~~46
s~. ~uG,
~
e oovxrlr. FLORIDA: _ .
~ ` This b ~ deeLration ei Domi~e and tXtizeasbip In the State d Florida flat I am
~ tlds dq ie aoooedaoea. and b
eoaiormit,T with Section 1;22.17. Florida Statutes.
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I was i~ a 1esa1 resident et and I
ICft71 IstaW
resided at floweret. I changed ap domic~7e to
ISerNt ae~ riasbwl
snd am and have besa a bona fide resident d the State d Flaida shoe daT eI
r 17 and I hide at S' ~ ~ Q
t8a.rt saa
c~ ST. LUG 1 E Conntj,>!7or;da, .
IQbI
and this statement b to be taken s, m, declaration d eitisensbip. actual legal residenos and domieSe is the State d Florida..
IF FOR THE PURPOSE OF ENROt.LiNG IF FOR .HOMESTEAD PURPOSESi
CHILDREN IN SCHOOLS PLEASE STATE PLEASE CHECK:
THEIR MAMES:
199 AUG I S AN i~ 28
. - 8REUOCA RET .F~A:
CLERK CIRCUIT COURT
- REC060 VERIFtEO
45SQ4s
I FtJRT~R CEItT7>`'Y that I wn71 register at m7 loeil address when the registration books reopen. and eompiT with all
r other sequirements d a legal resident d this State. .
s
I FUATI~11: CER1'!FY that I have no intention to return to mT former domic~7e. and I intend to semain in
C Countg.
lCit~?
Florida. permanea x
s
c
. bGOUNTyc
o _
. - v ~
N
ama
Swan to and sabsa~'bed before me tbb _~u daT d .
R AS CLERK OF CIRCUIT GOURT
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S LUG I E COUNTY, f LOR t OA - - ~
EPUTY LERK $OGK~~~ PAGEi~II,t
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