HomeMy WebLinkAbout0755 ~ic:~a~~ui ~ ~~t^iliCl~G ~~C~ ~,,fit~`__,E ii.• t at~:~
4~yp?S'7
TO THE CLERK OF THE CIRCUIT COURT. - -
ST. LUG 1 E - ootnaTx. ~,oRtnw:
' This is~boy decLration of Domiele and Citi:ens>tip in the State of Florida that I am 51ing this day in soourdaaae. and in
oonformitj with Section 222.17. Florida Statutes. ~ '
- - ~ hats Ic sic ~ h'l o • andl
I was forme a legal resident o~i (StaW
j~ tCStyl
resided at ^ ~ ~ G ~ t2 l SAO ~ ~ _ Howwer.I have changed my domic9e to
~>~~N~~ - ~ !8~ day et
and am and have been a bona fide resident of the State of Fbrida since ~ -Y«~ ( ~
• and I reside at ~ D ~ 3 ~Gt r i~ w O C~ C'~~ ~ `V'~ `
e _ 19~. i~taedNnmb.r) -
~y . 1... u Li 2. ST. LUG 1 E County. FJosida.
5
t
i
and this statement is to be taken as m1 declaration of citizenship, actusl legal residence and-domieik is the State d Florida.
- If fOR NOMESTEAQ ?URPOSES~
If fOR THE PURPOSE Of ENROLLING. pLEASE"CHECK:
CHILDREN fN SCHOOL, PLEASE STATE
THEIR NAMES. - - i
~eYi~ be rr _
4
_ ~ . 'c
' X919 S~~ 25 PN 12 22 ~
~ FILEO ANO kECuKUEQ
_ ~ S ROGy~~TRASA
_ CLERK CIRCWj CO~
. RECORO VER±FtE4 ~
4'SU25'~
I FURTIiER CEATII'"Y that I w~ register at my local address when the registration books reopen. and comply with s11 f
` other regninments ai s legal resident ~ this State.
FURTHER CERTIFY that I have no intention to return to my former domicile. and 1 intend Lo remain in
` l T u t 1 E _ qty
Florida, permanend;
.
i
~~tiry -
~i w`~~~., c~G~
i
~
• ,t '
l ~?C~F C~uj~~ ~Q 3
~ ~
(AdBe+rl
i
Sworn to and snbscn'bed before me this S day of i
v~ rNi c e ~b e~~~l
_ o - A.D.19
~ •
ROGER POiTRAS. CLERK OF CtRGU1T COURT
ST. LUG 1 E COUNTY, FtOFt i DA - , -
$Y: .
_ E PUTY LERK g00~~~~ ~ `