HomeMy WebLinkAbout1511 .
uecla~a~?~c~i ~ oY ~-~~ci~e anu ~i•~i~~~ ~~i ~~N
. W_
- - • • ~~ss
'FO THE CLERK OF TAE CIRCUIT COURT.
- !
ST•. L UC 1 E COUNTY, ~,Og,~A;
. .
~ `,'1'bls is m7 declaration at Domia'1e and (~tisenship in the State aI Florida that I am fliag this daT in aooor+danoe. ind is
_ conformitT with Sedioa 222.17, F7arida Statute:.
' I was formerh a legal resident os ~u ~ N t `1" ~ ~ ~LL -and I
resided at ~ ~ ~y'~ VLF ~ /2[~2s ~ I~~p - flowerer. i have ebana+ed mT domin7e to
(Str.et aad Nmaberl
and am and have been a bona fde resident of the State of Florida since daT of
l/
.19
7~ . and I reside at ~T ~ S ~0 ~ ~y~ ~ ~3g
Itlw.t aad Jimbar
' 1/fsJ~2C'~ ~~A CN ~T~--RUC-~E- ~p~Aly J~ ConntT.l:7oaida.
1(~l
and this statement is to be taken as m~ declaration of dtisensbip. actual legal residence and domide in the State of Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
CHILDREN IN SCHOOL,-PLEASE STATE PLEASE CHECK:
THEIR NANESS
fIIEU dN~ • • CEO
=T. lUS!i' r ~ • FLA.
aECO~? .
DEC 2O (O~ 59 ~ `~g
. ~ :rr-
r
.
I FURTAER CF.RTTFIC that I w~71 register at m~ local address when the registration books reopen, and oomph with all
other requirements opt a legal resident oaf this State. I
I FURTAER CEBTII~'Y that I have no intention to return to m~ former domiule. and I in nd to remain in
~ _ 1 E ~N / N 1 CouatT.
CK~)
Florida. permanencl;.
_ '
~ ~ ~ i
v ~ ~ ~ / ~ ~ Cj ~~t~l 'cwt- ~ -
- (NameL~
I
'e.. t! ~ 02 0 tAeer...l
sworn to and sobsa~'bed before me tbi, dad of
_ l~
ee 2M ek A.D_ i9_ ~1 ~ ..l v l; a de ~ ~A.~-ri ~/o -
'
ROGER POITRAS. CLERK OF CIRCUIT COURT _ .
ST. LUG1E COUNTY, FLORIDA -
- .
B Y : ~2titie~~
EPUTY LERK