HomeMy WebLinkAbout1726 464631
'FO THE CLERK OF THE CIRCUIT COURT.
S~. LIJG 1 E CO~gy. ~,p~A; -
. ,
~ 4'his is my detLration of Domicile and Citiunsbip in the State of Florida that I am filing this day in aowrdanos. and in
wnformity with Section TL2.17, Florida Statutes.
I was former] a Legal resident of ~ Q~~h t In ~ and 1
`-~7 IQt~) (State)
resided at y e T ~ Z- h 11~ . however, I have chAnged my domicile to
(Street aadNumber) -
and am and have been a bona Sde resident of the State of Florida since .,,LS~T'T- day of
, 19~~, and I reside at D D ~ ~E' h S C v l Z~ crl
(9treet and Number)
~O v % ,~i ~ e V c_ ~ _ ST , l UG 1 E County. Florida,
(~ri)
and this statement is to be taken as my declaration of atizenship. actual 1ega1 residence and donva7e in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
GHILbREN IN SCHOOL, PLEASE STATE PLEASE CHECK:
THEIR NAMES:
s
~~'9 rlo -2 8~ ~
fILEO Ahl CLk: c
ST,LIiCiE COUNTY.f~:..
ROGER POITRAS
CLERK CiRCU17 C~::{'
~s4s31
I FURTHER G'ERTIFY that I wt71 rrgister at my Local address when the registration books reopen. and wmply with all
oilier requirements of a Legal resident of this State.
I FURTHER CERTIFY that I have no intention to return to m_v former domicile, and I intend to remain in
T. U C I E _ County.
_ ICiy) _
F•'{orida, permanenti~.
J ---t :OG -
f CCUtIj (Address) t
59•orn toand snbsm ore me this ~ _ day of o J D 3 1~C~1n.~.n;S,,o~~L ~ Cl
ROGER FOITRAS. CLERK OF CIRCUIT COl~2T ~ Q-f j S G80oY~1!~
ST. L.UG 1 E COUNTY, FtOR t OA
BY: • t
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' EPUTY LERK .
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