HomeMy WebLinkAbout2787 L1 L:1...1C.~ ? t1~.,; ::?~.~t~~.: c:.t ~l.! VIIIL.V'11~1.;'_J I
4~~28'7 ~ ~
TO THE CLERK OF THE CIRCUIT COURT.
S~'. L UC 1 E -COUNTY. >~-i,pRm~:
~ Y'his is my decLration of Domicile and Citizensbip•in the State of Florida that I am fling this day in aocordanx. and is
conformity witL Section ?~Z.17, Florida Statutes.
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I was formerh a legal resident of /mss ~ i and I
r ~ ~ n ((St,l . (sw,el
resided at J O ~ ~ Iio:vc.er, I l;aie tLaaa~d ~y d~~~e Lo
(Sued and Nambet) -
and am and have been: bona fide resident of the State of Florida sioct ~ ~ ~ day of
1y ~
r,~,Q'f -19~ and I reside at ~ '
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~ (9treet and Nambet)
` , 1 ~ ,L,~_ ST . LUG-1 E County, Florida,
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and this stattment is to be taken u my declaration of atizenship. actual Legal residence and domiule in the State of Florida,
IF FOR THE PURPOSE OF ENROLLING IF FOR HONESTEAD~PURPOSES~~
CHILDREN IN SCHOOLr PLEASE STATE _ PLEASE CHECK: ~ 1
THEIR NAMES:
s ~ - ~-~.Q~w~
~~~s -s ~R, 20
~~1LEL %-nL tiECL,.u;U
SLLUCIE C~U4TY.Ft~.
ROGER PQ! ~ R~ S _
C.ERK CIR.CU{i C?~F;
4~'~28'7
I FURTHER CERTIFY that I will register at my IocaI address when the registration books reopen. and comply with aD
other requu~ements of a legal resident of this State.
I FURTHER CERTIFY th:t I have no intention to return to my former domic~7e, and I intend to amain in
T. U C I E „County,
(City) .
Florida. permanenti~:
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sworn to and snbsrn~ed before me this _ nay of AZ.! ~~~~~C.GC[.~.[
• , 79 .
RQGER POITRAS. CLERK OF CIRCUIT GOURT ~ ~ ~ .
1 ~ - ~ •
ST. IUGIE GOUNT7, FtOR~ A -
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BY: ~ ,
EPU7Y LERK
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