HomeMy WebLinkAbout2422 Declaration o~ Docnic~te anc~ t~?~~?L~:nship l r/
. ~ 457300
700 THE CLERK OF THE CIRCUIT COURT. -
STy LUG 1 E COUIVTY~ ~,p~A;
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_ ~ 1Lis is ~ daeLratjon d DomieDe and Clti:enship in the State d ~orida that I am SCmR this dq is aooord:sne. and 1,
ooniozmitF with Seeticn 222.1T. Flo ida Statutes.
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I was formcrl a legal resident d ~ ~ I
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resided at . ~ B /~at,~ Sfi • - Haweer. I 1~ave cia~ed aq domicle t.
' (Shed aed Nambsr) -
_ aad am and have been a bona fide resident d the State d Florida since ~ / ~ 7 daT d
_ _ _
19 7 Y _ and I reside a: yo
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and this statement is to be taken as mT declaration d citisenship. actual legal residence and daminle is the State d I:7orida.
If fOR THE PURPOSE Of ENROLLING If FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL, PLEASE STATE Pt.EASE CHECK:
THEIR NAMES:
i
~~ss s~P -s ~ jr zs
F EO A!m RECflitOED
~R'OG~ER
P~OITRAS ~
aE~K t~1C11tT CQ!
. ~E6'OM VEAIFtEO
457300
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I FURTHER CERTIFY that I w~11 register at m7 local sddress when the registration books reopen. and oomplT witL all
~ other requirements d a legal resided aI this State.
f
~ I FIJRT~ CERTg'Y that I have na intention to return to m_? former damio'k. and I intend to remain a
7. U C I E . Conat?.
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Fbrida. permanenilj.
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Swam to and sobsrr~•bed before me this ~ daT d - - -
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ROGER P01 TRAS. CLERK OF' C I RCU 1 T COURT
ST. LUG i E COUNTY, fLOR 1 OA -
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BY: -
' EPUTY LERK
~ PACE „r~.~ i
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