HomeMy WebLinkAbout2788 t..1,.• ? . ? _,i l + _ t i.. ? • t ~ Q l l l1 V I l I L l;, l • . } . ; . J
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TO THE CLERK OF THE CZItCUIT COURT.
S~. LUG 1 E COUNTY. FLORIDA:
This is mJ decLratioa of Domin7e and Citisensbip in the State of Florida that I am Ming tba daJ in accordance. and in
_ coaformitJ wilb Section 271.17, Florida Statutes.
`r ' I was former] a ]tga] resident of ~ and I
•~7) (Blatt)
resided a1 , C--,a-L, S]aw~rer. I halec~:.b~d n7 dc~s~e ttt
(Street and Number) -
and am and have been a bona 5de resident of Lbe State of F]orida siacr ~ ' " daJ of
~ L~-~-' • -19~ and I reside at ~ U ~-t ~
.~A • 0~ • (3treet and Nambc)
,r o ST. L UG f E CountJ. Florid:.
ttstJ)
and this statement is to be taken as my declaration of citizenship, actual legal residence and domicile in the State of Florida.
fF FOR THE PURPOSE OF ENROLLING IF FOR HOHESTEAO PURPOSES,
CHIIOREN-IN SCHOOLS PLEASE STATE PLEASE CHECK:
THElR NAMES:
ar
'~79 i~~r~ -8 ~~f 21
- FttEO FhC ~cL~;:u:U
stl.U,lE COUVTI'.rt.i.
ROGLR POITRAS
CLERK CiR~+11T CCUF'
a-]~J~~O
I FURTHER t;EERTIFY that I will register at my local address when the registration books reopen, and complJ with all
other regairements of a legal resident of this State.
I FUR that I ave qo intention to return to my former domiu7e. and I intend io remain in
• T. U G I E CountJ~
ICtq) _
F•)orida. permanenti~:
_ _ ~ C ~`U,1,~y
~J•~ G ? `C
(13a7De)
>FCOfJY iY. ~b~
_a
(Add,.aal
Sworn to and mbsaibed before me this daJ of
•
. A_D.19
~ ~1 - _ - -
r
ROGER POITRAS. CLERK OF CiRGUIT GOI~tT
~ ~
1 • .
ST. LUG ! E GOUN7Y, FLOR 1 DA
. ,
BY: ~ ~ - .r
EPUTY t.ERK
- • 8~3~9 Pa~E2~75