HomeMy WebLinkAbout0884 ~ -
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~~~jar~ation a~ -Domicte~ and Cif~zens~ii~~~___
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- 4s64oo
700 T~ t~.ERK OF TAE CIIiCtTIT (COURT.
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STS. L UC ! E OOUN17f. FIARID~:
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~ `'This b ~ detLration ei DamkIk and ~ ~ •
- _ ~atarmitf wltD 8eetion 222.17. Florida Statutes. ~ the Slate et I~7osids flat I am buns this dp in aeoadaaos. and b
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I waslarax a kFal resident d _ i!(.C~I/~e~~II.. SC.. andI
• ~ _ ICtU?1 tseNii
resided d Aowersr. I bare eLan=ed m0? doaoie3ls to
IStrNt aea Namb~M
_ and am sod bare been a bona fide resident at the 84te d Florida since ~ ~ d
~ 19~.. and I reside at
~~?~.c.~. ~ ST. lUC 1 E~
i~ Coant~. >!7odda.
and this statement k to be taken as n~ deciaratioa o! citisensbip. actual kgat resideaos and domicile is tba State d 1:7a:ida.
IF FOR 7ME PURPOSE Of ENROLLING If fOR HOMESTEAD PURPOSES
CHILDREN IN SCHOO>.r PLEASE ,STATE PLEASE CHECK:
THEIR NAMES:
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.1919 AU6 2~ PM ~ 05
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RECOPD VERiF1E
456400
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I FtJliTllgi CEA1`~'Y that I w>'fi register at m7 Ioca1 sddress when the registration boob reopen. and eomplf with a0
other regniremeata d a kgal resident d this State.
I FURTAER G'~IItTII~'Y that I have no intention to return to n~ former domie3k. sad I intend to remain is
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Florida. pe:maneosl;. -
' COUNry
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swam w and sob.a='bed before me this d,~ d
~.~9.79
R ERK OF CIRCUIT COURT
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ST. I E COUNTY, FtOR 1 OJI
BY: -
a
EPUTY LERK
~~315 r~E .