HomeMy WebLinkAbout2126 ..r
~ec:~ac~~~~c~ ~ e~i u~~ ~ ~rc;rre anc~ Vi-~~zensnr~ r~,
- ~ ~ 4'x'()569 .
'FO TAE Ci.ERR OF THE CDtCU1T OOURT. .
i
S~-. LUG 1 E OOUN'17t. FLORIDA:
~ This is m~ declaration ort Domiale aced t~tisansbip is the State aI Fbrida flat I am rains this dq is amadanee. and 1a
coniormitj with Section 222.17. Florida Statutes.
- - • I was tormerl a kgal resident of T 11 F 1 ~ /D ' and I
_ t 71 . 1
~ /7 / C ~ "o R y S T ~s
p X ~l 7 _ Aowe~er. I have dansed ms domici~a to`
IStreat and Namberl .
and am and have been a bona fide resident oithe State oiFlorida since ~ 9 7 7 ds~ d
~
~ ~ S -19 71~ . and I reside st x o` n ~ S ~ . .S ~ ~ ~ U ~ N /q
IStr.~t aced Iiambt)
~T' 5 T. ~ y c / ~ _ ST. LUG ! E Connt~. Flaarida. .
_ iC~t7)
and this statement is to be taken as m~ declaration ai atizenship, adtul legal residence and domin'1e in the State oiT Florida.
IF FOR THE PURPOSE OF ENROLLING IF FOR HOMESTEAD PURPOSES,
GHIIDREN IN SCHOOL,•PtEASE STATE PLEASE CHECK2
THEIR NAMES:
1919 OEC 26 P~ 2: 18
FILED ~?NG NECOn11lU
• ST.LIICi COUt1~Y.FlA.
RAf:~R PAI D1C
CLERK CIRCUIT COt1RJ
RFCQROYFRIF;f~
~'L'`2_~~ ;
4'4569
i
I FURTHER CERTII''Y that I wi11 register at m~ local address when the registration boob reopen. slid oomph with aII.
other requirements oil a kgai residtat aoi this State. I
I FURTAFR CERTIFY that I have no intention to return to m. former dominle. and I intend to remain in
j t . r`
ur
i ~ - CountT.
_ t(~t~)
Florida. permanents;.
~ ~
Sworw tb aced sq _ y ore me this ~ daT of ~ ~f' ~ • . • >s •
3, 5~.--
` ~ s'i ~ ~ Imo. .
- - yQ
ROGER •POITRAS. CLERK OF C IRGUI T COURT • .
. b-121Sc~ II
ST. LUG 1 E COUMY, FLOR t OA - _
B Y : ~ ~ 322 P~~~ 219
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