HomeMy WebLinkAbout0097 Declaration of Domicile and L<~zenshi
P
~O THE Q.ERK OFTHE CIRCUTi'OOURT. ~~"s~w7~.'~
•
ST-. L UG I E Qpv~y~ ~,p~~
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~ `;!'his is ~ dee]sratioa d Domicile and (Yti:enship in the State of Florida that I em 1i73nt this dq in sooordanoe, and is
- ~ eoaformip with Section 2?2.1T, Florida Statutes.
I was former, a kgd resident of asxl I
rasided at o ~ ~ However.I have changed mT domie~e to
tsssed.od No~st~
and am and have been a bona fide resident of the S4te of Fbrida since r~3 dsyF d
y N ,,,14~ and I reside at ~ ~J .S l~ft7fjfjr~-LC ~ ~
~'b.~T -G~c~~ ST. LUG I Et~aaN~e.r~
tats) C°°ntF' F7°r'd''
and this statement is to be taken as mT declaration of citizenship, acted kgd residence and domie=7e in the State d Florida.
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IF iOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
GHIIDREN IN SCHOOt.~ Pt.EASE STATE PLEASE CHECK:
THEIR NAMESS
yov~L.mS ./•4~L ~d~~J ~
_ 455~9R~
- _ 1919 ~E!~ 22 P'M 1' 31
E . EO ANO ~ TOY A.
SR~~~~~j
~LttRB yEp1FtE41--~"'""",
I FURTHER 4'F.'lt1'IF'Y that I w~71 register at mT locel addirss wbrn the rrgistratioa boobs reopeq and eomplT with all
other regairemmts of a legal resided of this State.
7 FURTHEtt CERTIFR that I have no intention to return to mT former domie~e. and I intend to remain is
U C E Conat~.
_ Il1it~) _ _
Florida, permanend~.
EGG
cc W,tr . ~ •,GO~..{jt...
~y~ ^ S. w /l~~B~CL C~..~~LE .
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Sworn to and:ab.~~a before me this Z-ds;
od _ /,,e7` sT ~y C , ~ . G~ .3.~~6 oa
A.D.1'il
~ .
ROGER POITRAS. CLERK OF CIRCUIT COURT ~
ST. LUG 1 E COUNTY, f LOR 1 UA
BY: ~ ~ ~J' • t
PUTY LERK g~l~K~'15 pIGE 9i ~
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