HomeMy WebLinkAbout2081 - ~
Ueciara~~ion of unrr~icie and titiizenship
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1001'1 (:t.ERK OF T~ C7RCtl1T OOURT. ~~5~i2
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S~. LUG 1 E ____-OOUN!'Y. FLORIDA: -
. ~ 1Ws is m,~ declaration eE Damidlt and Cltiseaship b the State o[ F'iorida that I am Ifliag Ibis dq b aoeo~dance. and b
_ oonfarmiq? with Section 222.17. Florida StatutK. -
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I was i~ a 1esa1 resident et N i and I
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resided at Z-1.1 t~l ~4-o t_ ~'t c ~ - However. I lava! cbanaed mT domia7e to
18er.et aai Namb.rl -
and am and have been a bona fide resident ottbe State a[Florida ainoe - _ daT d
- 19~... and I reside at o'w+ ~2_ ~ .
l r _ 18t~..t.ed I~Imab.el
~ e T ~•F• h v e. ~ ST. LUG 1 E ~ti. ,
tabl
and this statement is to be taken as mT declaration of dtisenahip. actual legal residence and domie9e b the State ei Florrida.
IF FOR-THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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(919 AUG ! 6 AM 34
. F fOAI~ppF~~ET~Yf A.
• s~~ P01TRA~
~>CIRCtAT COURT
flECORO YEAIfIEO
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1 FtJRTIIEB Cl:R1't>~ that I w~71 register at my local address when the registration books reopen. and eomplT with all
other requirements o[ a legal resident a[ this State.
I FUR'P~R CER1'lt'Y that I have no intention to return to mT former domia'le. and I intend to remain >a
U C Couat~,
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Florida. permanend;.
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¢ /Name)
Sato ~~le~...
sworn to and snhsaib~ed before me thi, dal of Yc~-'r S ~ . G~~~~t. _
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i A.D.19: ~I - - -
R S CLERK OF C 1 RCUI T COURT
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ST. LUG1 E COUNTY, f LOR t OA - -
~ BY: - R
• P uT Y J E R K BOOK~1~ PA6E~4
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