HomeMy WebLinkAbout1817 ; _
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TO THE CLERK OF THE CIRCUIT OOURT. .
ST. LUG I E covIaTlt. FzoRmA: E
' , Thii is'!gT declaration d Domicile and CItiseaship in the State d Florida that I am fiHag this d~ in aooordanae. and in
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oonfarletitT with Seetioa 222.17. Florida Statutes. - -
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I was forme a kgal resident d ~ /L p _ - pEi1/ /U _ and I
((5t~1 (elate)
resided at ~ SA ~,~5 d l't~ S T - Aowever. I have clanged mF domic~7e b-
- IStraat and NumDw1 - -
and am and have-been s bona fide resident of the State d Florida sinoeT~ daT d
~ .19~~.. and I reside at ~L ~ ~ 1
~ ~ • 01 ~x~
~O't.Z~ P.~/t.C~G ST L. UC 1 E~.Ddrr~~ Connb. ~ j
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and this statement is to be taken as m7 declaration d eltiumhip, actual legal residence and domia'k in the State ai Florida.
IF fOR THE PURPOSE Of ENROLLING If FOR HOMESTEAD PURPOSES
CHILDREN IN SCHOOL, PLEASE STATE PLEASE CHECK: ~s i
THEIR NAMES: _
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- FiLEO ANQ R~CURI)f-0
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CLERK CIRCtIR CO/
RELOAD VER!FiEC~
40 s
I FURTHER CERTIFY that I w~71 register at my local address when the registration books reopen, and oomplT with all }
other requirements at a legal resident of this State.
I F'tJRTT~R CERTIFY that I have no intention to return to m7 former domicRe, and I intend to remain in
T. U C I E - , CQnntJ.
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Florida. permanenV; .
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~ • and =n ~ before me this daY of iAdde.al
f ~ r~ ~ f ~_9__-
' ~~„~~tAS: CLERK OF CIRCUIT COURT
ST. LUG I E COUNTY, f tOR 1 A - _
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BY: _ -
EPUTY LERK
• 8~~3~7 ~E.~~.4
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