HomeMy WebLinkAbout2070 j.
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t~eciara~on or uomicite anoi Li~izenshi ~ ~
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l00 THE CLERK OF THE CIRCUIT OOURT. j~
S~•. LUG 1 E OOUNTY. FLORIDA: ,
~ l7~is is ~ deelacation d Domidk and Citizenship is the State d Fbrida that I am II>jns this ds,T is aooordaaos. and L
aontarmiy with Section 222.1?. lc7orida Statutes. - ~
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I was i~ a kcal resident d , - - and I #
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resided at / -Hoverer. I have ehang+ed a~ domicile to
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and am and bane been a bona fide resident d the State d Florida since ~ daj d
1l.~. and I reside at ~ t D,~ ~ ~ f ~
- 18tn.t aaa NroTerl
Gr ST, lUG 1 E Count.
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and this statement is to be taken as ~ declaration d atizeasbip. actual legal residence and domie3le in the State d Florid:.
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IF iOR gHE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,.:
CH I t.OREN I N SCHOOt., PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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1919 AU6 I6 AN ~ 31
ST
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COIN1iY. A.
ROGER POITRA~
CLERK CIRCUIT COURT
RECORD vER~EfEn__
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I FURTHER CERTIFY that I wt71 register at m7 loch address when the registration books reopen, ind oomp'IT with all
other requirements at? a legal resident d this State. -
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I F'[TRTHER tbst I have no intention to return to m~ former domicGe. and I intend to remain in
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Florida. permaaend;.
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t Sworn to and subscribed before me this daT d
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R A CLERK OF CIRCUIT COURT
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ST. I.UG 1 E COUNTY, f L 1 OA -
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BY: ~i ~
' _ UT L E R K $~3~,4 Pl~f j
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