HomeMy WebLinkAbout0929 - ~ -
Declaration of Domicile andV Cif izenshi+~- -
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' 456416 . -
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700 TAE CLERK OF TAE CIItCU1T COURT.
S~~ LUG 1 E COUNTY FLORIDA: .
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~ `~'l7~is is mJ deeLration of Domidis and tlftisensbip in the State of 1:7orida that I am IDins this dq is acoord:noe. and is
. _ oonformit,~ wild Seetios 2?5.17. I:'loarida S4tutes. -
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Iwasi~akgalreside~ot Blue Island ,I11~nois sadl. - t
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:e:adad ~ 13030 t~iood Street - Aowever. I have tbanaed ~ doa~iefie to . .
tS1sM! sea Nombad
_ and am and have been a bona fide resident otthe State a[Florida since t,.~o,_t,,._t t,; daj d ,
e.~yttstr .19 78 .andIresideat 2507 No. Indian River Drive
t8cr..t aid tlumLtl
Fort Pierce ST. LUG 1 E mid,, -
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and this statement is to be taken as mT declaration a[ otisenahip. adnal legal residence and domide in the State d 1.7ozida. -
IF FOR THE PURPOSE OF ENROLLING - IF FOR HOMESTEAD PURPOSE3;i.-'
CHIIOREN IN SCHOOL,-PLEASE STATE PLEASE CHECK:
THEIR NAMES:
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- 456416 n -
1919 AU& 21 PM ~ 14
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ClEAIt gRGNT CO -
RECORO VER1f1ED - - _ _ - _ - .
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I FtJRTI~R CERTIFY that I w~11 rsgisler st mT local address when the registration books reopen. and eocnplT with all f
other. regniremeats oCalegal~sident at this State.. _ _ _ - _ _ _ _ _ - _ - _ _
I F[IRTAER CERTIFY that I have no intention to return to mT former domi~e. and I intend to remsia in - ~
- ,T . i. v c ~ E ,Count=. _ -
Florida. per~nendi
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Swots to and snbea~'bed befora me this da at -
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A.D.19
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R K OF CIRCUIT GOtitT . -
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ST. L -COUNTY, 1'LOR 1 _ _
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~ BY: ~
EPUTY LERK oK~S p~GE ~ .
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