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HomeMy WebLinkAbout0877 ~ -7. - 1 ©~cl~~~tion- of Domicils end Citizenshi r 4 TO THE CLERIC OF THE CIRCUIT COURT. ~ - - Sr. ~ uG ! E oouhrrY, FLORIDA: - This is nq deetuatifln of AgmicDe and Citiaenghip is tiro State at Florida that I sm thing this dq ie accordance. and in - ;conformity with Section 212.17. Florida Statutes. . I vvaa former! a legal resident of __a~'~l' . ~ aad I ~ ~ - resided at however. I have ebinged my doir3cile to (SerssR aed NvaD~rl ~ - and amand have been a bona. fide resident of the Stale of I`'1trida sissce ~ dry of 19~~ and I reside st i (BtrMt Ns~be) i T~~ rr~~~-P_ ST. LUG I E - ~ti. a~oriaa. cam - - and thisr sUtement is to be taken:s m7 declaration of eitirensbip, arrant legal residenoa and domia7e in the State at Florida. - - LF FOR-TNE PURPOSE OF ENROLLING IF FOR NOMESTEAO PURPOSES, _ ~ CN 1 LOREN 1 N SCHOOL, PLE/lSE StATt: PLEASE CHECK: TNl;iR NANESS 1 r- ~ JA~122 ~ ~ 24 _ . - _ .3 ~ ~ - ~ Cp jTY.t'l~?. - - a~ TTRAS REt~Il6 VERIFIEO_---~~~' - - - - 4`~3~2 . - _ ~ - ~ I FURTHER CERTIFY that I wdl register at my local address when the registration boolra reopen, and eompllr with ag other requirements oaf a legal resident of this State. - I FURTHER CERTIFY that I have no intention to n'.mn tom former domid7e. and I intend to remain in U C 1 E -County lQtj) Fbrida. permanend;. - ~ - . _ - - E - ~Gp~NTY _ ? _ _ _ ~ by ~rt.?~~+,` P4r _ ~EC06 T(.F~~ - ' Sworn to Ore me this dry of ~ • ~.yp s ROGER PO I TRAS, CLERK OF -C IRGUI- f COrdRT SiLflS ~ AlnR~e r'Ve~R, ST. LUG i E COUNTY, ~ f LOR t OA - ~ - EPUTY LERK - _ - e~ _ . - - ,