HomeMy WebLinkAbout2717 tr l.. I C< 1 ~:4 i t.. t•. l.+ 1 1 V et ~i e u v t l l G. C t t J I t l lJ
' / 1
46'~1~4 ~ '
'FO THE CLERK OF THE CIRCUIT COURT.
ST~. LUG 1 E COU~y, ~,O~A; '
,
4'his is mJ dec]aration of Domic~7e and CYt,izenship is the State of Florida that I am 51ing this daJ in aooordanoe. and is
conformitJ with Section ?22.17. Florida Statutes.
' I was former] a kgal resident of ~Q^
d t71
G 4 S'!i ~ n a ~ n and I
IQt7) IS
rrsided at ~ ~ C ~ : • ~ ~ ' - Aowever. I have changed my domic~e to
(~ered and NvmDes) '1
and am and have been a bons Sde resident of the State of Florida since ~ V daJ of
_ ~ ~u r _ 19~. and i reside at TM" •
18tt+set and Number
~tYe"~ pj~ rc-r ~ ST. LUG I E CountJ.Florida,
tlSt7l
and this statement is to be taken as my declaration of otizenship, actual legal residence and domicile in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOS[S~
CHILDREN IN SCHOOL~•PLEASE STATE PLEASE CHECK:
THEIR NAMES: ,
~ t
y ss. ~ :cy;,~~i~ A
ROucB P.OI;RA~ <
GI.f.RK C~CL'7 tr.!?ffi~ i
- 4b'~1~4 I
I FURTHER CERTIFY that I wSl register at my loco] address when the registration books rropen, and comply with. aD
other requirements of a legal resident of this State.
I
I FURTHER CER1'g'Y that I have no intention to return to m_v former domiu"le. and I intend to remain in
~ T. U G I E ~ County.
I _ 1 ) _
i Florida, permaneaci~.
f
t
i
i
_ _
_ jj
r - , i
5
F
-
i Sworn to and sn i1~9r+e me thi7 ~C ~o dly Of ~O~ 'L' !rC ~C ~ `C1. 3~~~.Q~
7 "tom ..w, r ' ~
RpGEi~ ~FOt'l14AS. GL~t~~ OF' CIRCUIT COURT . ~
-
ST. LU~f:.f ~OUMY` ~'~.~.OR 1 A ,
' E PUTY LERK '
S _ }
t