HomeMy WebLinkAbout0371 Dec~arafiEan e~? ~Qn~~c~Ie and C,<<<zenship
456105
100 THE Q~RK OF TAE CIItCi11T OOURT,
Si'Y L UG i E BOUNTY. ~,p~A;
~ `;'lUis k nqI declaration d Domicile and G'Iti:easldp In the State of Florida that I am tdiag this d~ iD aooordsnoe. aad is
_ ecnlorani4T with Section 2?2.17. Florida Statutes. nn
r I was a kgal resided d D l A- IUD /'D U S _ ~ l U D/A AJ~4 and I
lpy) t8t+Ui
resided at l ~ 3 0 ~IeO F T - However. I have changed aq domieSe b
IStrsrt aoa Nombvl -
- and am and have been a bona 5de resident d the State adFlorida aiaoe o? a - da, d
~-fl~c~s ~ .19~~...andIreaideat ~30o s~A w~~/ rat. ~4/~T. D- 2-
tsa..c.na xambrrl
~T P/~'~ec 6 ~ ST. LUG 1 E ~ti, _
ICtb?1
and this statement is b be taken as m, declaration d dtisenabip. adual legal residence and domieik in the State d Florida.
If FOR THE PURPOSE Of ENROLLING If iOR NOMESTEAO PURPOSES,
CHILDREN IN SGNOOL,-PLEASE STATE PLEASE CHECK:
THEIR NAMES: /
~i~~N r f~ ~yBi~
:919 ,~'..'1 23 ~ ~ k3
F 1lf JUip~~pnli~~
STRL~t
~
G.EAI CIRCINT
RECQRO YERff
4105
C ~
I, -
I FIJRTHF.It CEl3TT>:'Y that I w~11 register at m7 local address ~vben the registntaon hooks reopen. and eompl, with all
other requirements d a legal reaide~ ad this State.
f -
I F[JRTIIER (~R1'!I•'Y thsti I have no intention to return to m7 former domicile, and I intend to remain is
T ~ u c E Conntj.
Florida. Permanendi
-
• ~
~
(Tlame)
ulddr.nl
Sworn b and snbaaibed before me this °2 3-~--~ aa, d 3 a`-o D~ 2-
w.D.19.
R K OF CIRCUIT COURT - ~ - _
y . •.U r. r. ~ •
ST. LUG 1 E COUNTY, f LOR 1 OJ1 - ~ ~ ~ o~~,'°''_ ' . ~
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