HomeMy WebLinkAbout0096 Declaration of Donnicile and L<i~Z~nshi~ ~
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100 THE G7.EItK OF THE CIIiCUIT OOURT.
$~y LUG 1 E _ OOUN'1'Y. FLORIDA: ,
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~ Plus b m~ declaration o~i Domide cad (Stizensbip in the State d Florida that I am SIiaE this dq is aooordanae. stud is
ooniormitj wKb Settiou 222.17. Florida Statutes.
'r ~ ~ Q ~UE ~ _ cad I
I wa: former a kgal rea~dent d
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resided at G~ ~ ' ` P~ ~ • lJi S ~A S~ C L M ~iR, _However. I have changed m7 domia'1a to
IStrsd. cad NomDsrl _
_ cad-am cad have been a bona Bde resident oaf the State dFlorida since ~ S Tlb ~ °T t
J U ti' -19 ? Q - cad I reside at (9d ~ ~O u~' ~ U• S • ~ i
18ae~t aedNnmbarl
'~,~F- ~i ~ R.C ~ _ ST. LUG 1 E Count7. Florid.. .
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• and this statement is to be taken as mT declaration of c3tisenship. actual legal residence and domide in the State d Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,t
CHILDREN IN SCHOOL. PLEASE STATE PLEASE CHECKS
THEIR NAMESS ~
AL'~,1' GNCl~R4gG0iJ
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4559~~
. 1919 AUK ~2 PN ~1= 29
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pQITRAS~
gRCUIT COURT
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I FURTHER CZ~'Y that I wt11 register at mT local address when the registration books reopen. and oomplT with all
other requirements d a kgal r+e:ide~ d this State.
I CERTII~'Y tb:t T have ao intention to return to m~ former domide. and I intend to remain is
- - ~ T . u c ~ E Countj.
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Florida. permaa~ndi
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Swoca to cad sabsa~'bed before me this ~ daT of -
. ~ A.D.19: ~ - 1
.79 ,
ROGER POITItAS. CLERK OF CIRCUIT GOt~2T . ~
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ST. LUG f E COUNTY, fLOR 1 - .
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BY. 4 -
• EP TY LERK
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