HomeMy WebLinkAbout0370 - _ n o{ ~ ?~icile and Cit~zenstii
Qecfaratio p
456104
FO THE t~.ERK OF TAE CDtCUIT COURT.
S~-. LUG 1 E COUNTY. ~-~,pRIDw; ,
. .
_ ~ `;1bis is nqI deeLratioa d DomicDe sad Cltiseaship is the State of Florida that I am i~E this da, is aooordanoe. sad is
- _ c~afo:mit, with Section 2?2.1T. Florida S4tntesw'
I was forme~rl a legal seside~ of 'vI If ~t i ~T7'A _ ~ PL' a and I
. ICWI 19t•W
resided ~ C /llr; - Aowever. I have changed m~ domidle to
IStrad aed Nambe:l •
and sm and have been a bona Bde resident of the State of Florida since ~ / f T d~ d
r
/~1~4~ W T ,19~ and I reside at G 7;Z ~ ~ N ~ e ~ .
18t+Nt asd I~doDsl
PORT r'. ST. LUG I E ~;da, •
and this statement is to be taken as ~ declaration of atizensbip, actual legal residence and domic9e in the State at Florida.
I.P FOR THE PURPOSE Of ENROLLING ~~f ;'#`Oq= HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL,-PLEASE STATE PLEASE•CHECK:
THEIR NAMES: -
Ti FI SRN,. Q n c.~ ~.r ~ .a ~oJe~,e~1
~'liEO~.?a:c 1f
`~..r1'~ f~~• ~~t7",/ X919 AU6 23 P!I ~ 43
ROG i POITRI
qty A'
a~x ca~ant j
RECORD VERIFIEp„•_
456104
• _
I FURTHER CEItTT1:'Y that I w~ register at m, local address when the registration books reopen. and oompl, with all
other regniremeaL d a legal resided at this State.
I FtJRT~R CERTIFY that I have no intention to return to m~ former doanies~e. and I intend to remain in
` T. U C I E . Conatj,
_ i~71 - .
Fbrida. permanead~.
tNam~
- L~~ ~ildw~t+s<
sworntoand wbsrn-bed before me this ~3-'-'~ da, of _ r ~T. L~{w t/ S .1~3 ~s~-
9 _ -
A.D.19
; ~1 - - •
R C K OF CIRCUIT COURT - -
y . ~
ST. LUG 1 E COUNTY, f i0R 1 OJ1 _ ~ ~ ~ 7~~~'
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