HomeMy WebLinkAbout0883 ~eclarafi~on of, Dorniciie and C~tiEZens~hip
456399
700 THE Q.ERK OF THE CIRCUIT OOURT.
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~`~'1~is is ~ deeLratioo of Danidle and Cttiseaship is the State oI Fiorida tba! I am Suns this das is sooordaaoe. and ie
eoafaemitT wKh Section 227E.1T, >:7orida Statutes.
" aadI
I was ~ a legal resident o~
ICRJI
resided at Aowewr. I haw ebansed ~ domieSa to
18h.et asa Nambd •
and am and bave been a bons foie r+esideat os the State o[ Fbrida ainoe ~ ~ / rCST ds~ d
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c~~~ -1l~.. sna I reside at ~a2Z
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St . u c t - _ ST, lUG I E Count. Florida. _
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and this statement is to be tal~en as >w declaration of dtisenship. actual legal residence a~ domicile in the state at Florida.
If FOR THE PURPOSE OF ENROLLING If FOR HOMESTEAD PURPOSES.,
CNILOREN IN SCHOOL,~PLEASE STATE PLEASE CNE6Kt
THEIR NAMESL
obERZ' t,.1. ~ ~1~o.~d
I F(TRTllEIt GEI;TII~'Y that I w~i register at mT local address when the registration boobs reopen. and oomph with aD
4 other regnir+emeats d a legal resided at this State.
~ I CERZ'gR thst I bave m intention to return to former domie~De. and I intend to remain in
T U C E _ Cannt~.
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FI°r'da' permaneatl,:
~9T9 AU6 21 PN ~ 04
~~EQ.!?~N~ R C p
RECORD VERiFiEO
b COUNT
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~ Swan to and sabemlted before me this dq a[ _Tt ~ V t~ c C•.~.~~__ ~
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ROGER POITRAS. CLERK OF CIRCUIT COU2T
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ST. LUG! E GOUN71l, f LOR 1 W1
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• EPUTY t.ERK
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